Frequently Asked question

Assisted reproductive technology (ART) refers to methods where eggs or “oocytes” are handled outside the body.

The most popular type of ART is in vitro fertilization (IVF). The term ‘in vitro’ means outside the body, so in the case of IVF, the eggs are fertilized in a lab dish instead of in the woman’s body, to create an embryo, which is then transferred into the uterus.

During this time, you take daily hormone shots to help your ovaries grow multiple eggs. You will also have several monitoring visits for blood tests and ultrasounds. When the eggs are ready, they are collected in a short procedure called an egg retrieval.

In the lab, the eggs are fertilized with sperm to create embryos. Embryos are grown for five to seven days. Some clinics freeze all embryos at this stage, while others may transfer an embryo right away.

The main steps of IVF:

• Ovarian stimulation: hormone injections to produce multiple eggs
• Egg retrieval ( OPU):- eggs are collected from the ovaries under anesthesia
• Fertilization: eggs are fertilized with the sperm in the lab
• Embryo culture: embryos are grown for 5-7 days
• Embryo transfer: a healthy embryo is placed in the uterus
• Pregnancy test- done after 2 weeks.

Yes, there are several alternatives to IVF, ranging from less invasive medical treatments to different family building pathways.

The main alternatives:

• Fertility medications ( letrozole/clomiphene/ gonadotrophins)
• Intrauterine insemination
• Fertility sparing surgery (laparoscopy/ tubal surgery)
• IVM (IN VITRO MATURATION)
• Third party reproduction(donor gametes)
• Surrogacy
• Adoption

According to the 2018 Society for Assisted Reproductive Technology, live births rates per intended egg retrieval by age group.

• Women <35 years: Live births - 47.6%
  • 35-37 years: Live births - 30.7%
  • 38-40 years: Live births - 21.7%
  • 41-42 years: Live births - 10.4%
  • >42 years: Live births - 3%

A complete IVF cycle typically takes 4-8 weeks from the start of hormone injections to a pregnancy test.

Breakdown of timeline:

• Phase 1: Pre -cycle preparation and testing- 1 month
• Phase 2 :Ovarian stimulation: 9-14 days
• Phase 3:Egg retrieval:20-30 min
• Phase 4:Fertilization and embryo culture: 5-7 days
• Phase 5:Embryo transfer: 5-15 min
• Phase 6:Pregnancy test- 14 days

While an active IVF treatment lasts about 1-2 months from the initial consultation to completion, the timings may vary beyond a basic cycle if the patient opts for:

• Genetic testing of embryos
• Frozen embryo transfer

IVF involves predictable points of physical discomfort –

• injection shots may cause stinging/bruising
• hormones may lead to bloating and mood swing
• egg retrieval is done under anesthesia, so its not painful. Post pickup cramping and spotting may be present for a day or two.
• Embryo transfer may be uncomfortable but generally not painful.

The physical aspect of pain may be well controlled with minimal medications, it is the emotional journey which may be demanding. Leaning on a partner / counselor is invaluable for emotional health.

Using donor gametes is IVF standard, successful path to parenthood for many. The decision is personal and based on financial, legal and emotional considerations.

Reasons for donor eggs:

• Decreased ovarian reserve
• Premature ovarian failure
• Recurrent IVF failure

Donor Sperms:

• Severe male factor infertility
• Genetic conditions
• Recurrent pregnancy loss

Yes, absolutely. You can do IVF after 40 and it is a common path for many women in their 40’s.

The core medical reality is that while IVF after 40 is possible, the success rates decline significantly due to decrease in the egg quality and quantity.

As per the US data, live birth per IVF cycle using own eggs:

• 41-42 years : Live births - 10.4%
• 42-43 years : Live births - 3%
• >45 years : less than 1%

Yes, it is possible to do IVF with low AMH, but the outcomes depend heavily on your age alongside your AMH.

Since AMH reflects the egg quantity, the focus shifts towards maximizing the quality of eggs you have. Challenges are fewer eggs are cycle cancellation.

Strategies for improved outcome:

• Certain supplements as COQ 10 and vitamin D and melatonin may be prescribed prior to IVF stimulation.
• Lifestyle modification to decrease systemic inflammation.
• A personalized stimulation protocol befitting you, may yield better outcomes. Embryo pooling and genetic testing may be advisable for advanced maternal age for optimal success.
• Newer advances for ovarian rejuvenation (PRP/ stem cell for ovaries/ rapamycin) to increase the egg count are still under trials.

Defining low sperm quality: the specific approach depends on which aspect of sperm quality is low.

• Oligospermia: when the count of sperms is low
• Asthenospermia: when the motility is low
• Teratozoospermia : when the size and shapes of sperms are deformed
• DNA fragmentation: this is to test the integrity of the genetic material

Yes, you can pursue IVF with low sperm quality.

In fact when IVF is combined with a specific technique called ICSI (Intracytoplasmic sperm insemination), is one of the most effective modalities for male factor infertility. The sperm for ICSI can be selected using advanced techniques like IMSI/PICSI/ ZYMOT and microfluidics for better outcomes.

When the sperm quantity is zero, you can access the treatment without sorting for donor sperms. Advanced procedures like TESE (testicular sperm extraction) and PESA
(percutaneous epididymal sperm aspiration) is widely available now.

IVF itself doesn’t substantially increase your risk of twins or multiples. That risk increases only when more than one embryo is transferred.

Advancements in technology have made single embryo transfer (SET) both safe and effective. SET means transferring one embryo at a time during IVF. It reduces the risks linked to multiple pregnancy for both the pregnant person and the baby.

The majority of studies have shown no significant increase in cancer risk for people who use IVF. While people with infertility may already have a slightly higher baseline risk of some cancers, this is linked to genetic or health factors rather than fertility treatment itself.

Before starting treatment, doctors conduct a thorough medical history and ensure patients are up to date on screenings, such as Pap smears and mammograms when age-appropriate.