FAQs

Before going for your appointment with a genetic counsellor, you can collect useful information to discuss with the specialist. You should talk with your family members about the history of the disease. Make sure to know the exact time of the onset and medical name of the condition.

Genetic counsellors indicate a variety of tests based on the health and condition of the patient. Some of the most common testings include – prenatal screenings, genetic screenings such as PGS, PGD and routine diagnostics.

A genetic panel is available to attend to all your doubts regarding fertility and genomics. You should ask your specialists about the extent of risk to your child, treatment options, advantages and risks associated with different types of treatments.

Preimplantation genetic diagnosis can detect the risk of approximately 600 genetic diseases including thalassaemia, sickle cell disease, cystic fibrosis, certain inherited cancers, Huntingdon’s disease, muscular dystrophies, and fragile-X. These tests have to be designed specially for each couple.

Gender determination is illegal in India and not done with PGD.

There is no evidence that suggests babies born after PGD are at the risk of having congenital problems or developmental issues.

PGD involves collecting cells from the embryo. This can damage or destroy the embryo. However, advances in the field of assisted reproductive technology and embryology have significantly improved survival rates for embryos through PGD. In rare cases, PGD may be unsuccessful in detecting the issue or give incorrect results.

The risk of having chromosomal abnormalities in eggs and embryos increases steeply after the age of 35 years in women. This increases the risk of implantation failures, miscarriages as well as congenital abnormalities in the baby. PGS can help in lowering these risks.

PGS involves collecting cells from the embryo. This can damage or destroy the embryo. However, advances in the field of assisted reproductive technology and embryology have significantly improved survival rates for embryos through PGS. In some cases, all embryos may be found with chromosomal issues resulting in a cancelled IVF cycle.

In certain situations, PGS can help in reducing the risk of implantation failure as well as risk of miscarriages as it allows the selection of the healthiest embryos for transfer. It also increases the chance of having a healthy baby and enables better diagnostic decisions.

A healthy embryo has 22 pairs of chromosomes and 2 sex (gender) chromosomes. Incorrect number of chromosomes or chromosome aneuploidy is known to be a major cause of IVF failures and miscarriages. In rare cases, if the pregnancy is carried to term, it can lead to congenital issues in the child.

Anyone can come to assess the semen sample to check their fertility status.

The test takes approximately 2-3 hours to complete.

In many cases, patients with obstructions in their fallopian tubes may experience no symptoms or may confuse their symptoms for something else. Regular gynaecological check-ups can help with early detection and timely intervention which can mitigate the long-term impact of tubal problems on fertility.

Fallopian tube blockage is often the result of inflammation of the fallopian tubes. This can be caused by sexually transmitted infections, endometriosis and surgery in the pelvic region among other conditions.

While there is no way to eliminate the risk of blockages in the fallopian tube, its impact can be minimised if it is detected early and treated accordingly.

Pregnancy with blocked fallopian tubes depends on the severity of the blockage. In some cases, surgical intervention can help correct these issues. ART procedures like IVF have helped women with tubal infertility conceive successfully.

Medical experts recommend trying to conceive for atleast one year before a fertility consultation for women younger than 35 years of age. For women over the age of 35 years, fertility consultation is recommended if pregnancy does not occur after 6 months of trying. In case of any health problems that indicate infertility like irregular periods or endometriosis, it is advisable to seek help before trying to become pregnant.

Smoking and consumption of other forms of tobacco is known to cause fertility problems in both men and women. Smoking can result in lower sperm count and poor sperm motility.

Common causes of male fertility include genetic defects, health problems (such as diabetes or STIs), varicoceles (enlarged veins in the testicles), sexual disorders (erectile dysfunction or premature ejaculation), overexposure to certain environmental factors such as radiation or chemicals, cigarette smoking, alcohol, certain medications, frequent exposure to heat as well as cancer or cancer treatment.

Female infertility can be the result of advanced maternal age (over the age of 35), ovulation disorders that affect the normal release of eggs from the ovaries, uterine or cervical abnormalities, fallopian tube blockage or damage, endometriosis, premature menopause, pelvic adhesion as well as certain types of cancer and cancer treatment.

Blastocyst culture is not suitable for everyone. If low number of oocytes are retrieved for fertilisation resulting in fewer embryos, there is a risk of them not growing up to the blastocyst stage.

Single embryo transfers are done to avoid multiple pregnancies and the risks associated with it. In a single embryo transfer, the healthiest embryo is selected and is known to be just as effective as multiple embryo transfers.

Excess good-quality blastocysts can be frozen and used in a FET cycle (Frozen embryo transfer). Research indicates that success rates of FET with blastocyst is almost equal to a fresh embryo transfer cycle.

ICSI is the acronym for intracytoplasmic sperm injection. It is an advanced IVF treatment that involves injecting a single sperm directly into the egg using a fine glass needle.

ICSI is recommended for couples with male infertility such as low count and poor-quality sperm or if the sperm was surgically retrieved. It is also recommended when conventional IVF therapy is ineffective or when genetic tests (PGS/PGD) are required.

Apart from the risks that come with conventional IVF treatment, there is a risk that the eggs may be damaged when they are cleaned or injected with sperm during an ICSI-IVF cycle.

ICSI is very successful in helping sperm fertilise the egg. However, like IVF several factors affect the success rate such as maternal age and cause of infertility.

IUI is the acronym for “Intrauterine Insemination” – a procedure to directly insert washed and concentrated sperm into the uterus to aid fertilisation.

IUI is a minimally invasive and safe procedure. Some women may experience mild cramps like menstrual cramps after insemination. In case of a stimulated IUI cycle, there is a risk of ovarian hyperstimulation (a rare but dangerous complication from hormone therapy) and multiple pregnancies.

Success rates of IUI depends on several factors such as cause of infertility, age of the female partner, use of hormone therapy and sperm quality. Many women may require several cycles of IUI to become successfully pregnant.

Intrauterine insemination is done near the time of ovulation. The washed sperm is placed into the uterus when the ovary releases an egg for the process of fertilisation. The ovulation period is different for every woman and is monitored when getting into IUI treatment.

IUI is not an extremely painful process. Some amount of discomfort might be felt during this process.

Some lifestyle changes are recommended after IUI. Do not smoke or consume alcohol and limit your intake of caffeine.

IVF is the acronym for In vitro fertilisation. It is the process of fertilisation of an egg with sperm outside the body in a carefully controlled environment and then transferring the embryo (fertilised egg) into the uterus of the gestational carrier (female partner or surrogate).

Many patients wonder how many fertility medication injections will be needed during the IVF cycle. There is no definite number. The frequency and dosage of medications depend entirely on the IVF plan specific to your age, reproductive health, and the health of your ovaries. This can range from 10-12 days of injections during the IVF cycle.

The success rate of IVF depends on many factors such as maternal age, cause of infertility, sperm, and egg health amongst others. Some couples might become pregnant right after the first IVF cycle while others might take several cycles. In some cases, couples might also be able to conceive naturally after their IVF cycle.

Before starting on IVF treatment, it is important to know the risks that might appear. Some of the risks of IVF could be side effects from the fertility medications, multiple pregnancies, ectopic pregnancies and ovarian hyperstimulation syndrome.

IVF is one of the preferred forms of ART (artificial reproductive technology) especially for specific causes of infertility. In the IVF procedure, the healthiest sperm and egg are chosen for fertilisation, post which the healthiest embryo is selected for implantation, thus increasing your chance of having a healthy baby.

ART stands for Assisted Reproductive Technology. It includes procedures such as IUI and IVF.

According to the World Health Organisation, Infertility is a “disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”.

Egg freezing and embryo freezing are established fertility preservation treatments. However, in some situations like fertility preservation for pre-pubescent girls (who have not yet started ovulating) or for women who cannot delay their cancer treatment, these techniques are not possible. In such situation, ovarian cortex freezing is recommended.

The process of harvesting and transplanting ovarian cortex is done in conjunction with the patient’s cancer treatment. It is suitable when there are time constraints because of the cancer treatment which makes conventional egg or embryo freezing unviable. Frozen ovarian tissue can be thawed and grafted back into the pelvis after completing chemotherapy.

Ovarian cortex freezing is an experimental procedure that has shown promising results. However, research is still limited as a significant number of patients who have undergone this procedure are yet to have their tissue reimplanted for medical or personal reasons.

While there is a need for further research in this field, there are no documented cases around the world where cancer was reintroduced into the body when transplanting ovarian tissue. This procedure is not recommended for certain cancers like leukemia, as the risk of reintroducing cancer is much higher.

Medical guidelines state that embryos can be frozen for 10 years. However, this can be extended for up to 55 years in special circumstances.

Frozen embryo transfers have been proven to be as effective as fresh embryo transfers to become pregnant.

Advances in cryopreservation (freezing) technology and use of cryoprotectants have significantly improved survival rates of embryos being frozen. As survival of the embryo through the freezing and thawing process significantly depends on its quality, only good quality embryos are selected for this process.

If you wish to transfer your frozen embryos to another clinic or city, both you and your partner will be required to give your informed consent by filling the relevant forms. These will be explained to you in further detail by your fertility care team.

Frozen sperm can be stored in a state of suspended animation indefinitely. Regulatory bodies have defined a maximum storage period of 10 years which is extended indefinitely for patients with medical conditions like cancer that can impair their fertility.

The sample is frozen using liquid nitrogen which is at a temperature of -196°C. Successful cryopreservation involves draining cell water and replacing it with cryoprotectant or antifreeze agents. This is done through simple osmosis. Once frozen, the sperm cells are in suspended animation where all metabolic activity is effectively stopped, enabling it to be stored as long as this temperature is maintained.

If the preliminary assessment of the sperm sample indicates absence of sperm (azoospermia), surgical extraction of sperm can be recommended to obtain sperm for freezing or fertility treatments

There is a small risk of the sperm not surviving the freezing and thawing process. However, advancements in cryopreservation technology and use of antifreeze agents have significantly reduced this risk.

Egg quality is said to deteriorate exponentially after a woman reaches a certain age (generally over the age of 35). In cases of advanced maternal age, apart from difficulty in natural conception, there is also a higher risk of the baby being born with congenital defects such as Down Syndrome. Women are advised to explore the option of egg freezing in their 20s or early 30s.

The whole cycle will take around 15 days and consists of a course of approximately 15 injections (the exact number may vary based on your ovarian reserve and response to the fertility medication.

The vitrification process involves dehydrating harvested eggs and replacing the fluid inside the egg with a special antifreeze agent or cryoprotectant to prevent the formation of ice crystals within the egg during the freezing process. Liquid nitrogen (-196°C) is used to flash freeze the egg. At this temperature, all metabolic activity is stopped, and the egg can be stored indefinitely in this suspended animation state.

Egg freezing is recommended for women who need to undergo cancer treatments. It is also helpful in situations where there is a higher risk of developing ovarian cancer or breast cancer especially if there is a family history of the same, considering egg freezing is recommended

For social egg freezing, guidelines state that maximum time for storage of frozen eggs is 10 years. For cancer fertility preservation, the stipulated duration is extended till use.

Most procedures involved in egg freezing are painless and during the egg retrieval process, you will be given general anaesthesia and will not be able to feel any pain during the procedure.

In some situations, egg or embryo freezing may not be viable like for women who cannot delay their treatments till the end of the ovarian stimulation protocol. In such cases, ovarian cortex freezing is recommended. It is an experimental procedure that has shown promising results around the world.

Common male sexual disorders include premature ejaculation, erectile dysfunction, and retrograde ejaculation.

The patient is given general anaesthesia during the procedure and will not feel any pain

Patients can expect slight discomfort in the penis, testicles, or rectum for a few days after the procedure. This is generally managed with over-the-counter painkillers. A course of antibiotics may be prescribed to minimise the risk of infection.

If electroejaculation is not effective for collecting adequate amount of sperm for treatments like IUI, IVF or IVF-ICSI, surgical sperm retrieval procedures like TESA, PESA, TESE and micro-TESE are recommended. These surgical sperm retrieval procedures are known to be very effective for harvesting sperm from male patients with mild to severe male factor infertility.

The testicular tissue biopsy process is done under anaesthesia and you will not be able to feel any pain during the procedure.

IVF is not recommended after surgical sperm retrieval as these procedures do not produce adequate amount of sperm for the procedure. Sperm harvested through these procedures is used in IVF-ICSI treatments where the sperm is directly injected into the centre of the egg to aid fertilisation.

Testicular tissue biopsy offers valuable insight into the rate of sperm development, presence of obstructions and abnormal growth. It helps identify if the cause of infertility is any obstruction in the tubes that transfer sperm into the seminal fluid or due to problems in sperm production.

Surgical sperm retrieval procedures include testicular sperm aspiration (TESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction (TESA) and micro TESE.

Subinguinal microsurgical varicocelectomy is performed under general anaesthesia and you should feel anything during the procedure.

Complete recovery typically takes between 2-3 weeks, but you can return to a sedentary job in 1-3 days.

Treatments for varicoceles present relatively few risks like developing a hydrocele (build-up of fluid around the testicle), recurrence of varicoceles, infection, and damage to an artery. Minimally invasive techniques like microsurgical varicocelectomy are aimed at minimising the risk of such complications while improving treatment outcomes.

Non-surgical treatment for varicoceles is called embolization, however, this procedure isn’t as widely used as surgery.

The number of viable sperm present in the fluid aspirated from the epididymis is generally too low for conventional IVF treatments and ICSI is recommended when sperm is retrieved surgically.

PESA is performed under local anaesthesia. The scrotum is numbed before the needle aspiration is done, and the patient will not experience any pain during the procedure.

PESA is a minimally invasive procedure that requires no hospitalisation. Patients can get back to their normal routine within 24 hours of the procedure.

Azoospermia or absence of sperm in semen can be caused by genetic issues like congenital absence of the vas deferens. It can also be the result of infections including sexually transmitted infections and certain medical treatments like cancer treatments.

There is no evidence which suggests lowered chances of conception with the use of surgically retrieved sperm or an increased risk of congenital issues in children conceived with the retrieved sperm either.

Hysteroscopy is a minimally invasive procedure that is performed under local anaesthesia. It can cause some mild discomfort during the procedure, like what you may experience during a pap smear.

Hysteroscopy is a safe procedure. In extremely rare cases, bleeding, infection, intrauterine scarring, or injury to the cervix, uterus, bowel, and bladder can occur.

Hysteroscopy has several benefits such as shorter hospital stays, lesser recovery time and lower post-operative pain. It also helps in diagnosing any anomaly inside the uterus that may be impacting the ability to become pregnant or carry a pregnancy to term.

Laparoscopy is performed under general anesthesia and is used for a detailed inspection of the uterus, ovaries, and fallopian tube. It is a keyhole procedure where the laparoscope is inserted through a small cut. Hysteroscopy does not require any incisions; however, it is done to look only inside the uterus. Hysteroscopy is often done in tandem with laparoscopy.

Laparoscopy is performed under general anaesthesia and you will not feel any pain during the procedure.

Recovery time may vary depending on the type of laparoscopy done. It is generally a day-care procedure that requires no hospitalisation, however if required, you may be admitted for 24 hours. You can resume daily activities after 2-3 days of rest.

Laparoscopy is a minimally invasive procedure associated with several benefits including shorter hospital stays, lesser recovery time and lower postoperative pain. It offers a much more detailed video of the reproductive system to diagnose and treat anomaly inside the uterus that may be impacting the ability to become pregnant or carry a pregnancy to term

As per guidelines set by the Indian Council of Medical Research, IVF centres cannot establish independent sperm banks. IVF clinics in India partner with reputed and licensed sperm banks which screen and store sperm.

All donors are asked for their extensive medical history including any genetic or underlying condition that they might be suffering from. The collected samples are further screened for a range of illnesses including HIV, HPV as well as for any genetic anomalies. The sample is then quarantined and frozen for 6 months before being thawed and reanalysed before use. This process helps in eliminating the risk of any infection from donor sperm.

As per guidelines set by the Indian Council of Medical Research, Egg donors are sourced from licensed government agencies where they undergo stringent screening to ensure the quality of harvested eggs while safeguarding the health of the donors.

Patients can specify physical characteristics like height which they desire in the donor as well as the blood type. The identity of the donor is kept strictly confidential as per government guidelines.

In a treatment cycle with “fresh” donor eggs, the patient (recipient) also undergoes hormone therapy alongside the donor to prepare the uterus for the embryo transfer process. If frozen donor eggs are used, the transfer is done when the patient’s uterine environment is optimal. Hormone based medications can be recommended if required.

ICMR guidelines state egg donors must be between the ages of 21 years – 35 years, with no history of genetic disorders. They are screened for viral markers like HIV and Hepatitis. Ovarian reserve testing is done to ascertain the quality of eggs in the donor.