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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.


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.

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

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

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

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

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.

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 

Infertility tests for men                               

  • General physical exam and medical history
  • Semen analysis 
  • Blood test - testosterone and other male hormones.
  • Ultrasound test - ejaculatory duct obstruction, retrograde ejaculation
  • Chlamydia test 

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.

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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