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Overview

Infertility: Treatment, Procedure, Cost and Side Effects

What is the treatment?

Infertility refers to a condition when a woman cannot conceive even after having carefully timed and unprotected sex for over a year. It is difficult to pinpoint the exact cause of infertility. However, it may occur due to inadequate levels of some hormones in both men and women and also due to trouble with ovulation in women. A man suffers from infertility if the semen that he ejaculates contains less number of sperms and if the sperm is of low quality. In such a scenario, a man will not be able to reproduce.

There are different factors which can contribute to a man getting infertile. A man can suffer from infertility if he suffers from a condition called varicoceles, or from diseases or conditions like diabetes, cystic fibrosis, trauma, infection, testicular failure or has been exposed to chemotherapy or radiation. Other causes may include alcohol addiction, smoking, use of anabolic steroids and exposure to environmental toxins. A woman can suffer from infertility if any of the organs such as the ovaries, fallopian tubes or the uterus gets damaged.

Treating infertility in men involves treatment for premature ejaculation, varicoceles, blockage of the ejaculation duct, retrograde ejaculation and also surgery for epididymal blockage. A woman may have to take some medications if she is suffering from ovulation disorders. Other treatments for women include intrauterine insemination and even surgery to restore fertility.

How is the treatment done?

A doctor may advise a couple to have more sex per week so as to enable the woman to conceive. However, infertility in men can be due to a number of different reasons and their treatments differ too. Medication and behavioral therapy can help a man to overcome general sexual problems like premature ejaculation and erectile dysfunction. A varicose vein in the scrotum, which can cause infertility, can be surgically removed. In case of blockage of the ejaculatory duct, sperm can be injected into an egg in the laboratory after it has been extracted directly from the testicles. Retrograde ejaculation is treated by taking sperm directly from the bladder and later injected into eggs. The epididymis is a coil-like structure in the testicles that help to store and transport sperm. Surgery can help to remove the blockage if it gets blocked.

A woman suffering from ovulation disorders will be prescribed fertility drugs like clomifene, metformin, human menopausal gonadotrophin, human chorionic gonadotrophin, bromocriptine and follicle stimulating hormone. In addition to these, there are surgical procedures for women. Fallopian tube surgery helps to repair damaged or scarred fallopian tubes and makes it easier for eggs to pass through them. Laparoscopic surgery also helps to increase fertility.

There are some methods which help in assisted conception like intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection, donating sperm or egg, assisted hatching and surgical sperm aspiration.

Who is eligible for the treatment? (When is the treatment done?)

A man should becomes eligible for treatment after he has been diagnosed as suffering from such by a doctor. This is because there are no apparent signs or symptoms of infertility in men. The quantity and quality of the semen also appear normal to the naked eye. Therefore the tests that can identify infertility in men are semen analysis, hormone testing, genetic testing, testicular biopsy, imaging and other specialty testing. In case of women, some of the conditions that may make them infertile are irregular or no menstrual periods, endometriosis, pelvic inflammatory disease, very painful periods or multiple miscarriages. Some of the specific fertility tests that help to understand whether a woman is infertile are ovulation testing, hysterosalpingography, ovarian reserve testing, hormone testing and imaging tests.

Who is not eligible for the treatment?

A person is known to be infertile if he/she has not being able to have a baby even after having frequent and unprotected sex for a year. A man or woman is not eligible for treatment if he/she has been able to make the partner conceive/ conceive herself after having unprotected sex. A person is also not eligible if none of the tests have been able to diagnose him/her as suffering from the condition.

Are there any side effects?

Oral fertility drugs produce milder effects than injectable fertility drugs. The most common side-effects of fertility drugs are bloating, breast tenderness, upset stomach, hot flashes, mood swings and headache. The side effects of gonadotrophins are headache, upset stomach, mood swings, acne, weight gain, abnormal menstrual bleeding, dizziness and even upper respiratory tract infection. Some of the serious side effects of fertility drugs are changes in vision, ectopic pregnancy, ovarian torsion, ovarian hyperstimulation syndrome and allergic reactions. However, the most common side-effect of infertility treatment is a multiple pregnancy.

What are the post-treatment guidelines?

A person should adopt a healthy lifestyle to make sure that he/she does not get affected by this condition. Smoking and consumption of alcohol increases the risks of infertility and should be avoided. It is of utmost importance for an overweight man to lose some weight. Both men and women should exercise as a sedentary lifestyle increases the risks of infertility. Furthermore, a healthy diet containing adequate quantities of folic acid, iron, zinc and vitamin B-12 should be adopted. A person should also reduce stress as it reduces the chances of conception.

How long does it take to recover?

A woman who has undergone laparoscopic surgery can probably go home on the day of the surgery itself. However, a woman will take about 2-3 weeks to recover from the surgery. Research has shown a person can again reproduce within a time span of 2 months- 2 years after successful treatment. A lot of factors determine how soon a person will recover after taking infertility drugs. Some of the factors are the person’s age, health, medical issues and others. A person taking clomiphene will normally see positive results after 5-12 days of taking the last clomiphene pill.

What is the price of the treatment in India?

The cost of laparoscopic surgery in India generally ranges between Rs 1 lakh to Rs 2 lakhs. The surgery to remove the varicose vein in the scrotum of a man may cost something between Rs 90,000 and Rs 1,50,000. Clomephene, used to treat infertility in women, costs around Rs 650 per cycle. The prices may vary with other variations of this drug. An ICSI treatment costs between Rs 1,50,000 to RS 2,50,000 while Frozen Embryo Transfer procedure will cost a patient an additional Rs 1,20,000.

Are the results of the treatment permanent?

A person who has undergone successful treatment for infertility is generally able to reproduce within 2 years. However, this is not a permanent result. A person may again have infertility problems due to leading an unhealthy lifestyle like smoking, drinking or by not being active. Some health issues also may have an effect on the fertility of men and women.

What are the alternatives to the treatment?

When infertility issues come up due to hormonal problems, using a natural progesterone cream can help a person to address it. Consumption of herbs like red raspberry leaf, nettle leaf, dandelion, alfalfa, red clover, maca and chaste tree berry also help to cure infertility. Getting enough sleep has also proved to play an important part in treating infertility problems.

Safety: Medium Effectiveness: High Timeliness: Medium Relative Risk: Medium Side Effects: Medium Time For Recovery: Medium Price Range:

1 lakhs to 3.7 lakhs

Popular Health Tips

Tubal Infection - Why Should You Get It Fixed Before IVF Planning?

MCH - Reproductive Medicine & Surgery, MS - Obstetrics & Gynaecology
IVF Specialist, Chennai
Tubal Infection - Why Should You Get It Fixed Before IVF Planning?

There are two tubes on either side which connect the ovaries to the uterus. These are the fallopian tubes, and in the majority of the cases, this is where the fusion between the egg and the sperm happens. If there is any problem in either of the fallopian tubes, then the egg cannot travel down into the uterus and there cannot be fusion. Tubal infection or salpingitis and blocked fallopian tubes are some of the most common causes of infertility. In some cases, the sperm may travel up the fallopian tube halfway till the area of blockage and fuse with the egg. This is known as ectopic pregnancy, which is out of place.

Tubal infection is often a result of sexually transmitted diseases including trichomonas, gonococci, and chlamydia. Other general bacteria like strep and staph also produce salpingitis. In most cases, tubal ligation per se is not an issue. However, it can cause problems like blocked tubes or hydrosalpinx. In these cases, the complications arise. In some women, treating these could be the cure for their infertility itself. Blocked fallopian tubes can stop the eggs from traveling down the ovaries and fuse with the sperm. If the block is removed, then infertility is solved. Similarly, if the tubes are filled with pus as a result of the infection, then it does not produce a conducive environment for fertilization.

With IVF being used as a treatment for infertility, the tubes need to be cleared for infection or blockages. These might continue to pose problems and reduce the overall success rate of IVF. These are easy to diagnose so that the infection can be completely cleared and pus drained if required. Surgical debridement can also be done if required so that the tubes are cleared. In some cases, a part of the tube may be removed so that the issue is addressed completely. A course of antibiotics is often required to completely clear the infection. After that, once ovulation is stimulated, then the eggs can travel down so that they can be retrieved and frozen for further use.

Undetected blocked fallopian tubes of silent infection (chronic salpingitis, which does not present with any symptoms) can be one of the causes of failure to conceive with IVF. This can be quite demotivating for both the couple and the medical team. With IVF, there is no clear role for the fallopian tubes, as the eggs can be retrieved from the ovaries and placed directly in the uterus. So, in severe cases of infection, the tube(s) may be even completely removed to improve chances of fertility.

8 people found this helpful

Thinning Of Endometrium - Can It Cause Problems In IVF?

MCH - Reproductive Medicine & Surgery, MS - Obstetrics & Gynaecology
IVF Specialist, Chennai
Thinning Of Endometrium - Can It Cause Problems In IVF?

With infertility on the rise, more and more couples are turning to IVF as a definitive solution. Though there are some inherent risks with IVF, the success rates have gone up significantly over the last couple of decades. This has made it extremely popular for a couple facing infertility. IVF is no longer just a physical issue but also a hugely emotional one.

There are various factors which determine the success rate of IVF, and a thin endometrium is one of them. This is the inner lining of the uterus which should facilitate transfer and growth of the embryo throughout the course of pregnancy.

Ideally, the endometrium should be about 7 to 8 mm thick and have a 3-layered structure on ultrasound. If it is too thin, it may not be able to support the implantation of the fertilized egg. Further, even if it supports initially, as the embryo continues to grow, it may not be able to support the weight, leading to possible miscarriages.

Causes of the thin endometrium:

  1. Reduced blood supply to the uterus
  2. Reduced levels of estrogen
  3. History of endometriosis
  4. Scar tissue from prior uterine infections or surgery
  5. Fibroids

While blood tests can help identify reduced estrogen levels, ultrasound can be used to measure blood flow to the uterus. The cause of thin endometrium needs to be addressed before going ahead with IVF so that the chances of success are increased.

Management:

  1. Estrogen supplements can be given if there is estrogen deficiency. This is essential to promote overall uterine health, which can sustain a healthy pregnancy.
  2. Surgically, uterine scraping where the top layers of the uterus are stimulated to produce a thicker lining. This is an outpatient procedure and produces excellent results in most women.
  3. Increased intake of L-arginine is another way to improve uterine health. It promotes blood flow, thickens the uterine lining, and improves the success rate. About 500 mg per day for about a month is considered beneficial.
  4. Uterine cleansing with for instance castor oil is another way to improve uterine lining.
  5. Uterine massage where herbal oils are used to massage the pelvis has also shown great results. It helps improve circulation to the uterus and surrounding reproductive organs and improves their overall health. This should be done about 2 to 3 months before IVF and stopped after IVF (can result in dislodgement!!)
  6. Acupuncture: Another well-established method to improve uterine lining and health is the use of acupuncture, as it improves circulation.
  7. Eating healthy, vitamin supplements if required, getting adequate rest, moderate workout, and quitting smoking all go a long way in improving uterine health.
4 people found this helpful

Intracytoplasmic Sperm Injection (ICSI) - Know More About This Procedure!

MBBS Bachelor of Medicine and Bachelor of Surgery, DNB - Obstetrics & Gynecology, DGO
IVF Specialist, Delhi
Intracytoplasmic Sperm Injection (ICSI) - Know More About This Procedure!

Intracytoplasmic Sperm Injection (ICSI) is an artificial procedure similar to IVF. This technique is mostly preferred in case of severe male infertility issues like ejaculatory failure, low sperm count and Azoospermia. ICSI is a refined version of IVF where a single sperm is strengthened and injected into female ova (egg) to initiate conception. The diagnostic and screening process is similar to IVF. ICSI is recommended when:

  • The shape of the sperm is abnormal
  • The previous IVF cycle fails to produce any fertilized egg. In this scenario, ICSI technique may be used for the next IVF cycle
  • The sperm is not strong enough to reach the female egg through natural means
  • A male who had vasectomy previously needs sperm to be extracted to fertilize the female egg

ICSI-IVF Procedure:

  • Ovarian fertility drugs are given to a woman by an embryologist to produce healthy eggs for fertilization and follicles are examined by ultrasounds and blood tests until eggs get matured.
  • Eggs are retrieved from the female ovary with the help of a tiny needle that is attached to the ultrasound probe.
  • Fresh sperms are collected on the same day of fertilization and placed in a culture with eggs.
  • Each egg is then injected with sperm and left for fertilization.
  • The embryo thus formed, if found good enough, is transferred to the uterus through the catheter with ultrasound.

Advantages

  • As mentioned earlier, ICSI could help in producing a genetic child even when the male has fertility issues.
  • There is a greater chance of fertilization and embryo formation in ICSI compared to IVF.
  • The success rates of ICSI and IVF are similar and ICSI can be away when the cause of infertility cannot be determined.

Risks involved

  • The side effects in ICSI are similar to those associated with IVF.
  • Multiple pregnancies, OHS (Ovarian Hyperstimulation Syndrome) due to stimulating drugs administered for IVF and embryo growth failure.
  • Since ICSI requires precision while injecting sperm, there is a rare possibility of damage to the egg if not done carefully.
  • The male offspring produced through ICSI may have infertility issues passed genetically.

Some couples have already used ICSI successfully and rate it highly as it is convenient and the possibility of congenital disabilities is minimal. The advantages of ICSI far outweigh the risks involved. In case you have a concern or query you can always consult an expert & get answers to your questions!

3186 people found this helpful

Frozen Embryo Transfer - Complications Associated With It!

MBBS Bachelor of Medicine and Bachelor of Surgery
IVF Specialist, Udaipur
Frozen Embryo Transfer - Complications Associated With It!

Frozen Embryo Transfer or FET is an extremely effective method to conceive a pregnancy. Recent studies have proved that there is a increased chance for pregnancy when the embryos, which get used are frozen and get placed inside the uterus at a time right after the ovaries are stimulated. Still, certain issues can arise with the transfer of frozen embryo, such as:

A Thin Lining of the Uterus
Research has shown that there are not many women who get pregnant if the lining in their uterine does not tend to thicken enough. It is not clear exactly why this problem occurs in most women and moreover there is no sure shot treatment to make the lining of the uterine thick. The experts on fertility would try out different methods like increasing the amount of estrogen or change the way how estrogen is given. There are other instances when women might be given supplemental medicines, while for some, the problem will continue to exist.

What Should Be Done In Case The Problem Persists?

  • In case the problem continues for some women, then there are certain approaches which experts might look to adopt. The first one is to cancel the transfer of embryo and try once again at any later stage, that too with a different treatment method.
  • The second option which they could think of is to go ahead with the transfer, wherein they might feel that a thin lining does not necessarily mean that it is impossible for a woman to get pregnant but definitely the efficiency would be reduced.
  • One last option is to make use of the opportunity for undergoing additional tests which would help them to assess the ability of the uterus to allow implantation of the embryos.

Unexpected Ovulation
For enabling the embryos to get implanted into uterus, placing them very precisely and at the appropriate time is important. This is regarded as the window of implantation. The time taken, is based on the time frame since progesterone reaches the lining of the uterine.

Doctor knows the exact time to place the embryos, right from the time he or she instructs a woman to start having progesterone supplements. In case a woman was to ovulate, the production of progesterone would begin earlier than the normal time and would lead to the shift of the window of implantation. As identifying the correct time of ovulation is almost impossible, so that would lead to some sort of uncertainty into the timing.

Due to this reason, there are doctors who would use medication in order to prevent unexpected ovulation from occurring. Generally an injection called Lupron is usually used as medication.

Timing for the Embryo Transfer is Inappropriate
This is a problem related to early ovulation. There are case when the implantation window is shifted, still the timing of the transfer becomes accurate. Recent studies have shown that quite a nominal percentage of women might have a window of implantation, which could be either earlier or later than normal time. A test called the Endometrial Receptivity Array can help determine at what time is the window of implantation open. In case you have a concern or query you can always consult an expert & get answers to your questions!

3161 people found this helpful

Diabetes And Infertility In Females - Understanding The Relation!

MBBS Bachelor of Medicine and Bachelor of Surgery, DGO
IVF Specialist, Gurgaon
Diabetes And Infertility In Females - Understanding The Relation!

Diabetes is often associated with heart diseases. In fact, many people do not know that their kidneys and eyes, too, can be affected due to the increased blood sugar levels. Fertility is often forgotten in this list. Yes, diabetes can lower the fertility rates. In men, it can cause erectile dysfunction and decrease libido. In women, the issues are different. But you should not lose hope if you are a diabetic and want to get pregnant. Controlled sugar levels and healthy body weight can help you become a mother. It should also be understood that diabetes alone cannot be the reason for you not getting pregnant. Several underlying factors such as obesity, polycystic ovary syndrome (PCOS), and irregular periods can be responsible as well.

Diabetes and hormonal disturbances: PCOS results in higher amounts of testosterone, which is the male hormones. This leads to abnormal periods, or at times, the periods are absent in women affected with this disorder. PCOS is often associated with obesity and type 2 diabetes. In women affected by diabetes, the fertility period is lowered. For instance, if a woman without diabetes can conceive up to 40 years, the diabetic woman can conceive up to 34 to 36 years only. This also means that menopause occurs early in such women. Oligomenorrhea and secondary amenorrhea are often connected to type 2 diabetes. It is also seen when these women have a control over their sugar levels, their fertility rate improves.

Type 1 diabetes and fertility: When a woman is affected by type 1 diabetes, mensuration ceases in most cases. Studies indicate that only 2 percent of the women who are affected by type 1 diabetes are able to conceive. While treatment can bring back mensuration in these women, irregular periods cannot be treated successfully. With controlled sugar levels, one can find chances of improved fertility rates. For this, even during the planning period, the woman has to control sugar levels. You can still become pregnant even when you are dependent on insulin. Your requirement dosage can differ. So, check with your primary care provider and gynecologist on the same. Your sugar levels should also be under control throughout your pregnancy.

Type 2 diabetes and fertility: In case of type 2 diabetes, which has begun to develop even in young women, there is a negative impact on the fertility rates. In the past, type 2 diabetes, also known as diabetes mellitus, was common only in the age group of 45 and above. But, lifestyle modifications and food habits have made it common even in the younger age group recently. This has resulted in the lowering of the fertile years and an early advancement of menopause. In women who have hormonal imbalance and diabetes, the combo paves the way to PCOS. Obesity is one of the reasons that trigger both diabetes and PCOS. With additional healthcare, you can become pregnant with diabetes mellitus. A healthy diet plan and exercise routine are recommended by the doctors.

If you are diabetic and planning for pregnancy, ensure that you take proper care to manage blood sugar levels. Enhanced glucose levels can only increase the risk for diabetes in the child. A healthy pregnancy is assured with controlled diabetes.

3496 people found this helpful

Popular Questions & Answers

Today I have taken hsg injection to rupture the follicle on 11th day. Before that I was prescribe to have fer pill kit tablet. Shall I continue to have those tablets?

MD - Obstetrtics & Gynaecology, FCPS, DGO, Diploma of the Faculty of Family Planning (DFFP)
Gynaecologist, Mumbai
Most of medical problems need personally taking detailed medical history and examination with need of new + old reports (more so in such treatment) so meet concerned doctor-treating Gynecologist or infertility specialist.
1 person found this helpful

Hi Dr. Mai 1 years se conceive karne ki kosish kar rahi hu. Kuch din pehle meyne ek infertility specialist se consult kiya or Dr. ne mere ek tvs scan kiya or bola ke mujhe pcos hey. Please help me.

MS - Obstetrics and Gynaecology, DNB OBGYN, ART Diploma
IVF Specialist, Mumbai
Lybrate-user, aapki umar mein PCOS common hain. Vajan thoda kum karne ki koshish karna. Agar period time pe aa rahe ho toh PCOS aapko jyada takleef nahi dega. Husband ke semen ki test bhi jaroor karna.
6 people found this helpful

Doc has given me puregraf 75 iu injection followed by 150 iu than again 150 iu injections still not ovulated can doc please tell me why?

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology, Positive Psychiatry and Mental Health
Psychologist, Palakkad
Dear user. I can understand. Please don't be panic. I suggest you to consult a gynecologist in person. We are here to help you in every aspect of your mental and physical health. Any sexual or psychological problems can be cured with the help of various methods and therapies. I suggest you to post your query with every detail here. We will help you in overcoming your problems certainly. Take care.

Hi I am 28 year old female married since 2 yrs. Actually my period was irregular since 6 months. My last period was 29 apr 16. So I went to local gynaecologist and for her prescribed I did prolactin test and the result was high abt 48 and having pcos by usg test. And then she suggested me to go for ct scan and I did that also but report was normal. But yesterday I came to know that I am I am 5 weeks pregnant. I am very much afraid whether to continue with pregnancy or go for abortion. I am afraid of that ct scan will affect my baby's growth. And what abt pcos. Please help me out. If I go for abortion will it affect to next baby or is there any chances of infertility in future? Please guide me. Thank you.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology, Positive Psychiatry and Mental Health
Psychologist, Palakkad
Dear user. I can understand. Please don't be panic. I suggest you to consult a gynecologist in person. We are here to help you in every aspect of your mental and physical health. Any sexual or psychological problems can be cured with the help of various methods and therapies. I suggest you to post your query with every detail here. We will help you in overcoming your problems certainly. Take care.

Table of Content

What is the treatment?
How is the treatment done?
Who is eligible for the treatment? (When is the treatment done?)
Who is not eligible for the treatment?
Are there any side effects?
What are the post-treatment guidelines?
How long does it take to recover?
What is the price of the treatment in India?
Are the results of the treatment permanent?
What are the alternatives to the treatment?
Play video
Infertility
There are many causes of infertility, including some that medical intervention can treat.The main symptom is an inability to get pregnant. In many cases, there are no additional symptoms.
Play video
Infertility
Infertility happens when a couple cannot conceive after having regular unprotected sex.While there may be many causes for the same , stress is the major cause.
Play video
Role Of Stress In Infertility
stress boosts levels of stress hormones, such as adrenaline, catecholamines, and cortisol, which can inhibit the release of the body s main hormone, gonadotropin releasing hormone, which is responsible for the release of sex hormones. Subsequently, this may suppress ovulation in women, reduce sperm count in men and lower libido in both women and men.
Play video
Male Infertility
Techniques of TESA, Micro-TESA, ICSI can be used to give a child to couples with their own sperms even if there is no sperm in the semen.
Play video
Infertility Treatment Prior To IVF
In vitro fertilization (IVF) is a remarkable and complex process in which sperm and egg are united outside the body and implanted into a woman s reproductive tract. Many treatments significantly improve the chances of getting pregnant. They include hormone treatments, fertility drugs and surgery.
Having issues? Consult a doctor for medical advice