FAQs
Female Infertility Work Up
What tests are commonly included in a female infertility evaluation?
Common tests include hormonal blood tests (e.g., FSH, LH, AMH, and thyroid levels), ultrasound for ovarian and uterine assessment, hysterosalpingography (HSG) or sonohysterography to check for tubal blockages, and ovulation tracking.
How long should I try to conceive before seeking an infertility work-up?
Women under 35 are advised to seek evaluation after one year of trying; those 35 or older should consult a specialist after six months due to declining fertility with age.
Can lifestyle factors affect the results of an infertility work-up?
Yes, factors such as stress, obesity, smoking, excessive alcohol consumption, and poor nutrition can influence reproductive health and may impact the findings of the evaluation.
Are infertility work-ups painful or invasive?
Most procedures are minimally invasive, though some, like HSG, can cause mild discomfort. Providers aim to minimise pain with appropriate preparation and support.
Blastocyst Culture And Transfer
Why is blastocyst culture and transfer preferred over day-3 embryo transfer?
It allows for better selection of embryos with higher implantation chances, mimicking the natural timing of embryo arrival in the uterus and improving success rates.
Does every embryo reach the blastocyst stage during culture?
No, not all embryos develop into blastocysts. The ability to reach this stage depends on embryo quality and laboratory conditions, which may influence the success of the process.
Is blastocyst transfer riskier than earlier-stage embryo transfer?
Blastocyst transfer is generally safe, but it may slightly increase the risk of multiple pregnancies if more than one blastocyst is transferred. Single blastocyst transfer reduces this risk significantly.
Can blastocyst culture improve the chances of a healthy pregnancy?
Yes, by selecting embryos with better developmental potential, it increases the likelihood of successful implantation and reduces the risk of miscarriage.
DNA Fragmentation Index Test
How are donor eggs selected for compatibility?
Donors are matched based on physical traits, blood type, and thorough medical screening to ensure the best possible compatibility and health outcomes.
Does using donor eggs affect the baby’s genetics?
The baby will inherit the genetic material of the donor. However, epigenetic factors from the recipient can influence gene expression during pregnancy, providing a unique biological connection.
What emotional challenges might arise in using donor eggs?
Recipients may experience feelings of loss over genetic ties or societal stigma. Professional counselling helps address these concerns and supports emotional readiness.
Can donor oocyte programmes support ethical and cultural sensitivities?
Yes, programmes follow strict ethical guidelines and can accommodate specific cultural or religious preferences, ensuring respect for diverse values.
Donor Oocyte Program
Why is the DFI test important in fertility evaluations?
It provides insights into sperm DNA integrity, helping to diagnose unexplained infertility, recurrent miscarriages, or failed IVF attempts, even when standard semen analysis is normal.
What causes high DNA fragmentation in sperm?
Common causes include oxidative stress, infections, exposure to toxins, smoking, excessive heat, poor lifestyle habits, and advanced paternal age.
Can high DFI levels be treated or improved?
Yes, treatments include lifestyle changes, antioxidants, managing medical conditions, or advanced reproductive techniques like ICSI, which select healthier sperm for fertilisation.
When is the DFI test recommended?
It is advised for couples experiencing infertility, recurrent miscarriages, or repeated assisted reproductive failures, especially if male factor infertility is suspected.
Embryo Transfer
Can stress impact the outcome of an embryo transfer?
Yes, excessive stress can affect hormonal balance and uterine receptivity. Relaxation techniques like mindfulness or acupuncture are often recommended during this time.
What happens if the embryo doesn’t implant after transfer?
Implantation failure may result from embryo quality, uterine conditions, or other unknown factors. A detailed review of protocol and possible adjustments are made for future attempts.
Is it normal to feel no symptoms after embryo transfer?
Absolutely. Many successful pregnancies occur without noticeable symptoms after transfer. Symptoms are not a reliable indicator of outcome.
Does the position or activity level of the patient affect success?
Post-transfer bed rest has not shown improved success rates. Patients are encouraged to resume normal activities with moderate physical care to promote overall well-being.
Endometrial Receptivity Assay
Can ERA help in cases of recurrent implantation failure?
Yes, ERA is particularly beneficial for individuals with repeated IVF failures, as it identifies the precise timing for transferring embryos when the endometrium is most receptive.
Does the ERA result remain consistent for future cycles?
In most cases, the receptive window remains consistent. However, hormonal fluctuations or medical conditions may occasionally require reassessment.
How is the ERA procedure different from a regular endometrial biopsy?
While both involve tissue sampling, ERA uses advanced molecular techniques to study over 200 genes linked to receptivity, providing tailored insights rather than general observations.
Can ERA be useful for natural conception timing?
While primarily used for IVF, ERA insights may guide natural conception attempts for couples facing unexplained infertility, aligning intercourse or insemination with the receptive period.
Endometrial Regeneration
Can the endometrium regenerate after damage from surgery or infection?
Yes, the endometrium can regenerate, but chronic damage, such as from Asherman’s Syndrome, may require advanced treatments like stem cell therapy or hormonal support.
How do stem cells contribute to endometrial regeneration?
Stem cells, particularly mesenchymal stem cells, can aid in repairing damaged endometrial tissue by promoting cell growth, reducing inflammation, and restoring function.
Does endometrial thickness always indicate successful regeneration?
Not necessarily. While thickness is a marker, factors like blood flow, hormone levels, and cellular structure also determine whether the regenerated endometrium is functionally receptive.
Can lifestyle impact endometrial regeneration?
Absolutely. Proper nutrition, regular exercise, and avoiding toxins like smoking can enhance endometrial healing and promote optimal uterine health for conception.
Fertility Preservation
Does freezing eggs or embryos affect their quality over time?
No, modern cryopreservation techniques maintain the quality of eggs and embryos indefinitely, ensuring they are viable when needed, regardless of storage duration.
Is fertility preservation only for women?
No, men can freeze sperm, and advancements like testicular tissue freezing offer options for prepubescent boys, expanding preservation opportunities across genders and age groups.
How does cancer treatment impact fertility preservation options?
Treatments like chemotherapy or radiation can harm fertility. Fertility preservation before treatment, such as egg or sperm freezing, provides a chance for biological parenthood post-recovery.
Can lifestyle changes serve as a form of fertility preservation?
Yes, maintaining a healthy weight, avoiding smoking, managing stress, and limiting environmental toxin exposure can help preserve fertility naturally and delay reproductive decline.
Hysteroscopy
Can hysteroscopy improve fertility outcomes?
Yes, it can. By removing uterine abnormalities like septa or scarring, hysteroscopy optimises the uterine environment, enhancing implantation chances and reducing miscarriage risks.
Is hysteroscopy painful or invasive?
While minimally invasive, discomfort varies by individual. Diagnostic hysteroscopy often requires no anaesthesia, whereas operative procedures may involve sedation or general anaesthesia.
Can hysteroscopy detect issues undetected by ultrasound?
Yes, hysteroscopy provides a detailed view of the uterine lining, identifying subtle abnormalities missed on imaging like transvaginal ultrasounds or HSGs.
Does hysteroscopy have applications beyond fertility treatment?
Absolutely. It’s used to manage heavy periods, remove retained products of conception, and assess postmenopausal bleeding, making it a versatile tool for overall uterine health.
Intracytoplasmic Sperm Injection
Can ICSI help if no sperm is found in the ejaculate?
Yes, surgical sperm retrieval techniques like TESA or PESA can obtain sperm directly from the testes, which can then be used in ICSI to achieve fertilisation.
Does ICSI increase the chances of having twins or triplets?
No, ICSI itself doesn’t increase multiples. The risk depends on the number of embryos transferred, as with traditional IVF. Single embryo transfer minimises this risk.
Can ICSI help when eggs fail to fertilise in IVF?
Absolutely. ICSI is often recommended after previous IVF cycles with poor fertilisation rates, as it bypasses natural barriers to fertilisation.
Does the quality of the selected sperm influence ICSI success?
Yes, even with ICSI, sperm quality affects embryo development. Advanced techniques like IMSI or PICSI can help select healthier sperm for better outcomes.
Intrauterine Insemination
Can IUI be used for male infertility?
Yes, IUI is often used for male infertility when sperm count or motility is low. It allows for a higher concentration of sperm to reach the egg, improving chances of fertilisation.
Is IUI effective for women with irregular periods?
Yes, IUI can be combined with ovulation-stimulating medications for women with irregular cycles, improving the chances of ovulation and increasing the likelihood of a successful pregnancy.
Does IUI guarantee pregnancy?
No, IUI does not guarantee pregnancy. It improves the chances, but success rates depend on factors such as age, sperm quality, and the underlying cause of infertility.
Can IUI be performed without fertility treatments?
Yes, IUI can be done with natural cycles, but it is typically more effective when combined with ovulation-stimulating medications, especially if there are fertility challenges.
IVF- Procedure
What happens if more than one embryo is transferred?
Transferring multiple embryos increases the chances of pregnancy but also raises the risk of multiple births. A single embryo transfer is recommended for many patients to reduce these risks.
Can IVF help women with no eggs or poor-quality eggs?
Yes, egg donors can be used in such cases. Donor eggs, combined with the partner’s sperm or donor sperm, can be fertilised via IVF, offering an opportunity for conception.
Does IVF treatment affect the success of future pregnancies?
IVF does not typically affect the long-term health of future pregnancies, but it may be influenced by factors like age, underlying infertility issues, and the quality of the embryos.
Why do IVF success rates vary so significantly between individuals?
Success rates vary due to factors like age, the cause of infertility, embryo quality, lifestyle habits, and the clinic's experience and technology. Each IVF journey is unique.
Laparoscopy
Can laparoscopy help diagnose infertility?
Yes, laparoscopy can identify conditions like endometriosis, blocked fallopian tubes, or uterine abnormalities that may be contributing to infertility, allowing for targeted treatment.
Is laparoscopy effective for treating ovarian cysts?
Yes, laparoscopy can be used to remove ovarian cysts. It is particularly beneficial for preserving the surrounding tissue and fertility while offering a quicker recovery compared to open surgery.
Does laparoscopy always require general anaesthesia?
In most cases, yes, as laparoscopy involves insertion of instruments into the abdomen. However, for less invasive procedures, local anaesthesia might be used depending on the complexity and the area being treated.
Can laparoscopy be performed during menstruation?
It is generally safe to perform laparoscopy during menstruation, though the menstrual flow can obscure the view of the pelvic organs. Doctors may prefer scheduling the procedure outside the menstrual cycle for better visibility.
Laser Assisted Hatching
When is laser-assisted hatching recommended?
It is typically recommended for women over 37, those with previous failed IVF cycles, or in cases where embryos have a thickened zona pellucida, potentially hindering implantation.
Does laser-assisted hatching increase the chances of IVF success?
While it can improve implantation rates for certain patients, the success of laser-assisted hatching depends on factors such as egg quality, embryo development, and the underlying cause of infertility.
Are there any risks associated with laser-assisted hatching?
The risks are minimal but include potential damage to the embryo if not performed correctly. It is important to use precise, controlled laser settings to ensure safety.
Can laser-assisted hatching be used for all embryos?
No, it is not necessary for all embryos. The procedure is generally reserved for specific situations where embryos might struggle to hatch naturally, such as those with thicker zona pellucida or in older patients
Male Infertility Work Up
How accurate is semen analysis in diagnosing male infertility?
Semen analysis is a critical first step, but it may not always provide a full picture. Repeated tests and additional diagnostics, such as sperm DNA fragmentation, may be necessary for accurate diagnosis.
Can lifestyle factors impact male fertility?
Yes, factors like smoking, excessive alcohol consumption, poor diet, and stress can negatively affect sperm quality. Optimising lifestyle choices often improves fertility outcomes.
Are there genetic tests for male infertility?
Yes, genetic testing can identify conditions like Klinefelter syndrome or Y-chromosome microdeletions, which may affect sperm production and fertility, providing insight into potential treatment options.
How can varicocele affect male fertility, and how is it diagnosed?
A varicocele, which is an enlargement of veins within the scrotum, can impair sperm production and quality. It is diagnosed through physical examination and confirmed via ultrasound or a semen analysis.
Surgical Sperm Retrieval
What methods are used for sperm retrieval?
Common methods include Testicular Sperm Aspiration (TESA), Percutaneous Epididymal Sperm Aspiration (PESA), and Microsurgical Epididymal Sperm Aspiration (MESA), depending on the cause of infertility.
Does surgical sperm retrieval affect future fertility?
In most cases, surgical sperm retrieval does not impact overall fertility, though the procedure may reduce sperm production temporarily. Long-term effects are rare, but regular follow-up is advised.
Is there a risk of infection after sperm retrieval?
Though rare, infection is a potential risk after surgical sperm retrieval. Antibiotics are often prescribed to reduce the likelihood of infection, and proper post-procedure care is essential.
Can sperm retrieved surgically be frozen for future use?
Yes, sperm retrieved surgically can be frozen and stored for future IVF cycles, ensuring fertility preservation even if the sperm quality decreases over time.
Ultrasonography
What are the benefits of using ultrasound over other imaging techniques?
Ultrasound is non-invasive, does not use radiation, and provides real-time imaging, making it ideal for monitoring pregnancies, detecting organ abnormalities, and guiding certain procedures.
Can ultrasonography detect infertility issues?
Yes, ultrasound can help identify conditions like ovarian cysts, uterine fibroids, endometriosis, and blocked fallopian tubes, which may contribute to infertility.
Are there any risks associated with ultrasound imaging?
Ultrasound is considered very safe, with no known risks or side effects. It does not involve radiation, making it a preferred imaging choice for pregnant women and children.
How is ultrasound used in guided medical procedures?
Ultrasound is often used to guide needle placement during procedures like biopsies, injections, and catheter placements, ensuring accuracy and minimising risk to surrounding tissues.
Pre Implantation Genetic Screening & Diagnosis
Why is Preimplantation Genetic Screening recommended in IVF?
PGS is recommended to identify embryos with the correct number of chromosomes, reducing the risk of miscarriage, improving IVF success rates, and lowering the risk of genetic disorders in the child.
Can PGD help prevent genetic diseases from being passed to offspring?
Yes, PGD is particularly useful for couples with a family history of genetic disorders, as it allows for the selection of embryos free from specific inherited conditions, ensuring healthier pregnancies.
What types of genetic conditions can PGD detect?
PGD can detect a wide range of inherited conditions, including cystic fibrosis, sickle cell anaemia, muscular dystrophy, and Tay-Sachs disease, by analysing the embryo’s DNA for known mutations.
Does Preimplantation Genetic Screening guarantee a healthy pregnancy?
No, while PGS increases the likelihood of a healthy pregnancy by selecting genetically normal embryos, it does not guarantee a successful pregnancy, as factors such as uterine health and embryo quality also play a role.