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Pregnancy is the result of a process that has many steps.

Women need functioning ovaries, fallopian tubes and a uterus to get pregnant. Infertility may result from a problem with any or several of the following steps. To get pregnant:

  • A woman's body must release an egg from one of her ovaries (ovulation).
  • A man's sperm must join with the egg along the way (fertilize).
  • The fertilized egg must go through a fallopian tube toward the uterus (womb).
  • The fertilized egg must attach to the inside of the uterus (implantation).

IVF - in vitro fertilization is the most common form of ART - Assisted Reproductive Technology. IVF is a type of assisted reproductive technology used for infertility treatment, a process of fertilization where an egg is combined with sperm outside the body, in vitro "in glass". IVF may be used to overcome female infertility where it is due to problems with the fallopian tubes, making in vivo fertilization difficult.

The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilize them in a liquid in a laboratory. The fertilized egg called zygote undergoes embryo culture for 2–6 days, and is then transferred to the same or another woman's uterus, with the intention of establishing a successful pregnancy.

Intracytoplasmic Sperm Injection (ICSI) is a specialised form of In Vitro Fertilization (IVF) which can assist in male infertility, where either the sperm numbers are very low or there is a defect in sperm quality and sperm has difficulty penetrating the egg cell. The sperm is injected directly into the egg cell. The use of ICSI has been found to increase the success rates of IVF.


Infertility refers to an inability to conceive after having regular unprotected sex. Infertility can also refer to the biological inability of an individual to contribute to conception or to a female who cannot carry a pregnancy to full term. In other words infertility refers to a couple that has failed to conceive after 12 months of regular sexual intercourse without the use of contraception.

Studies indicate that slightly over half of all cases of infertility are a result of female conditions, while the rest are caused by either sperm disorders or unidentified factors. Many cases of apparent infertility are treatable. Infertility may have a single cause in one of the partners, or it could be the result of a combination of factors.

In order to retrieve these multiple eggs for IVF, the woman must undergo injections with hormones and careful monitoring of her ovaries by ultrasound and her hormone levels by blood tests every day or every other day until she is ready for the egg retrieval. There are several methods of hormonal stimulation for IVF that basically can be divided into what we call “conventional stimulation” and “minimal stimulation,” or “mini-IVF.”

Eggs are retrieved by ultrasound guided needle aspiration under light sedation (in the operating room). This involves no surgical incision, and virtually no pain afterward. You just leave the hospital directly from the operating room, with no pain, and come back three days later to have the embryo (or embryos) placed very simply into the uterus through the cervix with a tiny catheter. No incision and no anesthetic are needed. An hour later you are able to go home.


Some health problems also increase the risk of infertility.

  • Irregular periods or no menstrual periods
  • Very painful periods
  • Endometriosis
  • Pelvic inflammatory disease
  • More than one miscarriage

The fertilized eggs (embryos) continue to grow in the laboratory for up to six days before being transferred into the womb. The best one or two embryos will be chosen for transfer. After egg collection, you will be given hormone medicines to help prepare the lining of the womb to receive the embryo.

Additional Risk factors for women's infertility:

  • Ovulation problems
  • Premature ovarian failure 
  • Blocked Fallopian tubes
  • Uterine problems- PCOS (Polycystic Ovary Syndrome)
  • Uterine fibroids- Submucosal fibroids
  • Poor egg quality
  • Overactive or  Underactive thyroid gland
  • Some chronic conditions such as AIDS or cancer
  • Age
  • Stress
  • Poor diet
  • Extreme weight gain or loss.
  • Severe Athletic training

The egg donation process lasts from three to six weeks each times eggs are extracted. Both the donor and the recipient who will carry the fertilized egg to term are given hormone therapy for the first few weeks to get them onto the same reproductive cycle.

The egg retrieval itself is a minimally invasive surgical procedure lasting 20–30 minutes, performed under sedation (but sometimes without any). A small ultrasound-guided needle is inserted through the vagina to aspirate the follicles in both ovaries, which extracts the eggs.


Most experts suggest at least one year for women younger than age 35. However, women aged 35 years or older should consult a doctor after 6 months of trying unsuccessfully.

  • Irregular periods or no menstrual periods
  • Very painful periods
  • Endometriosis
  • Pelvic inflammatory disease
  • More than one miscarriage

IVF is never the first step in the treatment of infertility except in cases of complete tubal blockage. Instead, it's reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven't worked. IVF can be used to treat infertility in the following patients:

  • Endometriosis
  • Blocked or damaged fallopian tubes
  • Women who have had their fallopian tubes removed
  • Women with ovulation disorders, premature ovarian failure, uterine fibroids
  • Any other problems with the uterus
  • Problems with ovulation
  • Antibody problems that harm sperm or eggs
  • Low sperm counts
  • The inability of sperm to penetrate or survive in the cervical mucus
  • An unexplained fertility problem
  • Individuals with a genetic disorder

Female Infertility tests:

  • General physical exam and medical history
  • Blood test - hormone levels and progesterone test
  • USG - Pelvic ultrasound - uterus, fallopian tubes, and ovaries.
  • HSG - Hysterosalpingography - to check uterus and the fallopian tubes
  • Laparoscopy - Check fallopian tubes, uterus and ovaries and endometriosis, scarring, blockages and any irregularities of the uterus and fallopian tubes.
  • Ovarian reserve testing to find out how effective the eggs are after ovulation.
  • Genetic testing  to find out whether its because of genetic abnormality
  • Chlamydia test
  • Thyroid function test
  • Tubal Patency 

There are five basic steps in the IVF and embryo transfer process:


  • Step 1: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. A trans-vaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.
  • Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs.
  • Step 3: The male sample of sperm is prepared for combining with the eggs.
  • Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilization. In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
  • Step 5: The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.


Some side effects of IVF / fertility medications may include:

Some minor discomfort and side effects are expected. Please convey the treating team about the discomfort or symptom you may be facing

  • Passing a small amount of fluid - clear or blood-tinged after the procedure
  • Mild cramping
  • Abdominal bloating
  • Constipation
  • Breast tenderness
  • Headaches
  • Mood swings
  • Abdominal pain
  • Heavy vaginal bleeding
  • Blood in the urine
  • Hot flashes
  • Weight gain

There are several ways uterine fibroids can reduce fertility. Changes in the shape of the cervix and uterus can affect the number of sperm that can enter the uterus.

  • IVF works where other infertility treatments fail
  • It can be used by anybody
  • You can use donated eggs and/or sperm
  • You have control over timing
  • Increase your chances of having a healthy baby
  • Decrease your chances of miscarriage
  • Increase your chances of conception


Intrauterine insemination (IUI) is an infertility treatment that is often called Artificial Insemination. In this procedure, specially prepared sperm are inserted into the woman's uterus. The woman may be given a low dose of ovary stimulating hormones.

IUI is more commonly done when the man has a low sperm count, decreased sperm motility, or when infertility does not have an identifiable cause. The procedure is also helpful for males suffering from severe erectile dysfunction. When ovulation occurs, a fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. The sperm is washed in a fluid and the best specimens are selected.

Assisted reproductive technology (ART) involves a significant physical, financial and emotional commitment on the part of a couple. Psychological stress and emotional problems are common, especially if in vitro fertilization (IVF) is unsuccessful. As with most medical procedures, there are potential risks like:

  • Multiples pregnancies including the increased risk of premature delivery and low birth weight.
  • Rates of miscarriage are similar to unassisted conception but the risk does increase with maternal age.
  • Ovarian hyper-stimulation syndrome (OHSS)
  • Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder.
  • ectopic pregnancy
  • Nausea or vomiting
  • Decreased urinary frequency
  • Shortness of breath
  • Faintness
  • Severe stomach pains and bloating

Assisted Reproductive Technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. ART procedures involve surgically removing eggs from a woman's ovaries, combining them with sperm in the laboratory and returning them to the woman's body.

ART procedures sometimes involve the use of donor eggs for the woman who cannot produce eggs (eggs from another woman), donor sperm or previously frozen embryos. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus.

You may choose to use donor eggs, sperm, or embryos.


Success rates vary and depend on many factors:

  • Infertility diagnosis
  • Age of the woman undergoing the procedure
  • Correctness of the procedure

The number of embryos transferred typically depends on the number of eggs collected and maternal age. As the rate of implantation decreases as women age, more eggs may be implanted depending on age to increase the likelihood of implantation. However, a greater number of eggs transferred increases the chances of having a multiples pregnancy. The doctor will discuss the procedure so you both agree on how many embryos to implant.

  • In vitro fertilization (IVF) is where fertilization is done outside of the body. Sperm are placed with unfertilized eggs in a Petri dish with the aim to fertilize the egg. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use (cryopreserved).
  • Zygote intra fallopian transfer (ZIFT) This is also called tubal embryo transfer. This treatment is used when a blockage in the fallopian tubes prevents the normal binding of sperm to the egg. Egg cells are removed from a woman's ovaries and fertilization occurs in the laboratory. Then the very young embryo, zygote is transferred to the fallopian tube.
  • Gamete intra fallopian transfer (GIFT) This involves transferring the sperm and eggs which are just mixed together before being inserted and with luck one of the eggs will become fertilized inside the fallopian tubes. Fertilization occurs in the woman's body.
  • Intra cytoplasmic sperm injection (ICSI) This is often used for couples with male factor infertility. In ICSI, a single sperm is injected into a mature egg to achieve fertilization. The fertilized egg (embryo) is then transferred to the woman’s uterus.

IVF was traditionally used to help both men and women address infertility issues. Women with missing, damaged, or blocked fallopian tubes were some of the first patients to carry successful IVFs. The egg is fertilized outside the female body and then placed inside the uterus for a more likely implantation.

Based on the couple’s test results and other factors, infertility may be treated with:

  • Medicine
  • Surgery
  • Artificial insemination IUI
  • Assisted Reproductive Technology (ART)
    • In vitro fertilization
    • Zygote transfer
    • Gamete transfer
    • ICSI - Intracytoplasmic Sperm Injection.
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