FAQ on IVF -

On the day before ooycte pick up, media in which oocyte need to be kept in CO2 incubator for equilibration. Media for sperm preparation and for follicular rinsing are also kept for equilibration.

Percentage of CO2 in Incubator and temperature is checked with the fyrite kit and thermometer respectively.

The pH of the media and osmolarity is also checked.

Oocyte identification and grading are always done in laminar hood, under microscope having a hot plate at a temperature of 37°C.

Once the oocyte identification is done, it will be kept in special endotoxin free disposable petridish in a special media. These petridishes are labelled with patient name and ART identification number.

A special needle is used to aspirate the follicle under ultrasound guided scanning machine.

The male partner is asked to collect the semen in a special container with his identification number. Semen is processed to get motile spermatozoa for insemination.

Embryology lab is a restricted entry area with a special air modules fixed to have a complete particle free area.

The blood pregnancy test is performed 12th day after the embryo transfer. If positive, patient is asked to repeat the blood test and ultrasound to ensure successful pregnancy by visualising foetal heart beat on 30th day after embryo transfer. A good antenatal care is required for a successful pregnancy. We have all the facility for that.

If pregnancy test shows negative result, couple can wait one or two complete menstrual cycles before beginning another ART cycle. Some times tests are required, that may delay subsequent cycles.

The miscarriage rate is about the same for ART as the general population. Since for ART patients we observe foetal sac in early stage, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages probably go unnoticed in the general population.

Spermatogenesis or sperm production cycle takes about 3 months time. Sperm quality on the egg retrieval day is often related to what happened in the male’s body 3 months ago. Listed below are some guide lines to help ensure that semen specimen on oocyte pickup day is of best possible quality:

Spermatogenesis or sperm production cycle takes about 3 months time. Sperm quality on the egg retrieval day is often related to what happened in the male’s body 3 months ago. Listed below are some guide lines to help ensure that semen specimen on oocyte pickup day is of best possible quality:

A fever more than 101°C within 3 months prior to ART treatment may adversely affect sperm quality. Sperm count and motility may appear normal, but fertilization may not occur. Body temperature should be maintained below 100 °C with medicines during or before ART cycle.

Any other medicine use should be brought into notice of fertility specialist doctor.

Avoid hot tubs, spas, jacuzzis, or saunas during 3 months prior to ART cycle.

Avoid heavy exercise. Physical activity at a moderate level is acceptable and encouraged.

Refrain from ejaculation for 2-3 days, but not more than 5 days prior to semen collection on oocyte pick up day

A woman is born with a full complement of eggs. There are far more eggs than will ever be used during a normal life time. IVF procedure has no measurable “lowering” effects.

Yes, woman can also be a mother after a tubal ligation operation. We offer two procedures:

Tubal Recanalization: This minor surgical procedure is done on outpatient basis with a success rate of about 80%.

IVF-ET: In this procedure eggs are fertilized outside the body and resultant embryos are transferred to the uterus, thus bypassing the fallopian tube.

Following are the indications for egg donation:

  • Poor egg quality
  • o
  • Premature ovarian failure
  • o
  • Age
  • o
  • Previous multiple IVF failure
  • o
  • Genetic cause

There are methods for determining the sex of a child, one involves the removal of a one cell from the embryo and other involves sperm sorting prior to insemination. Neither of these methods is guaranteed and we discouraged them for any reason other than screening of genetic disease.15.What is a day-3 FSH?

There are methods for determining the sex of a child, one involves the removal of a one cell from the embryo and other involves sperm sorting prior to insemination. Neither of these methods is guaranteed and we discouraged them for any reason other than screening of genetic disease.15.What is a day-3 FSH?

A single healthy pregnancy is the goal of any fertility clinic. The multiple birth rate depends on age, uterine condition, embryo implanted and quality of embryos. In our clinic 30% is twin pregnancy rate and 3% higher order birth rate

Following are the indication for IVF consideration:

  • Tubal problem
  • o
  • Male factor
  • o
  • Endometriosis
  • o
  • Unexplained infertility
  • o
  • Uterine problems
  • o
  • Age
  • o
  • Previous IUI failure
  • o
  • Ovulatory problems
  • o
  • Antibody problems that harm sperm or eggs
  • o
  • Cervical inhospitality

These are the basic five steps of an IVF cycle:

Ovulation induction: Injectable medicines are used to stimulate development of multiple mature follicles.

Egg retrieval: When the follicles are mature, the egg aspiration procedure is performed to remove the eggs. An ultrasound guided vaginal aspiration with special ovum pick up needle is a simple and easy procedure.

Fertilization and embryo culture: Sperms are either mixed or injected into an oocyte at various time intervals depending upon the maturity of the oocyte. The resultant embryos are cultured for 3 or for 5 days.

Embryo transfer: With the help of embryo transfer catheter embryos are delicately transferred near the top of the endometrial cavity.

Pregnancy test: About 11 days after embryo transfer a blood test is done for pregnancy hormone.

Assisted hatching [AZH] is a form of embryo micro manipulation that involves the creation of an opening in the outer covering called zona pellucida of the embryo. The procedure helps a normal, growing embryo hatch from the covering and implant in the uterus. This procedure increases the implantation rate. This thinning of zona can be done by three different ways chemical hatching, mechanical hatching and the latest is with diode laser technique.

After embryo transfer lying flat on a bed is best. Once can lie on one side or back, whoever is more comfortable. For sexual activities, as such there is no scientific studies done on this subject, but it is okay to resume normal sexual relations after three to four days from transfer.

A woman’s immune system might react against sperm, preventing fertilization or against an embryo, which either stops the embryo from implanting or rejects the embryo early in pregnancy, resulting in a miscarriage.

Preimplantation Genetic Diagnosis [PGD] is a technique that enables individuals with a specific inherited condition in their family to avoid passing on this condition to their children. In PGD one or two cells from an embryo are removed and tested for the presence of specific faulty gene. Only the embryos free from condition will then be transferred.

Estrogen is added to maintain the hormonal balance with in the endometrium. During egg retrieval, estrogen producing cells are aspirated along with the eggs, so there is a tendency for estrogen level to drop. If the estrogen level within the endometrium is too low, relative to progesterone level, destabilization of lining can occur to cause bleeding.

Any anatomical defect within the uterine cavity [polyps, sub mucous fibroids, adhesions or septum] may decrease the chance of pregnancy or increase the risk of miscarriage. The uterine cavity can be evaluated by hysterosalpingogram [HSG] or hysteroscopic mini surgical procedure, which allows the confirmation of the defect as well as treatment. Uterine polyps are benign [99%] out growths of the endometrial lining. The polyp acting as a foreign body” in the cavity may cause chronic irritation and interfere with embryo implantation. Hysteroscopic polyectomy [removal of poly p] improves pregnancy outcome in infertile women and should be considered prior to IVF.

Many scientific studies demonstrated a dramatic increase in sperm DNA fragmentation in obese man, leading to the significant reduction in sperm quality. There may be an increase in the miscarriage rate for men with high-level fragmented DNA damage.

Increased sperm DNA fragmentation due to oxidative stress may be due to many reasons – age more than 50 years, smoking, heat exposure, obesity and environmental toxins. Some of these sperm DNA fragmentation may be reversed. Use of antioxidants may improve sperm count, motility and possibly morphology before an IVF cycle.

Hypothyroidism [decreased thyroid function] is more common in woman with symptoms of cold intolerance, weight gain, dry skin, and menstrual irregularities such as menorrhagia [heavy perids] and/or amenorrhea [missed periods] , as well as galactorrhea [breast discharge].

Increased TSH [Thyroid Stimulating Hormone] production by the pituitary adversely affects the pituitary’s production of FSH [Follicle Stimulaitng hormone], which normally regulates ovarian hormone production thus leading to infertility and /or miscarriages.

Hypothyoridism can be treated with oral thyroid supplementation. If pregnancy occurs, due to increased metabolic demand more supplementation of oral thyroid medication is required.

POF is a loss of ovarian function in women under 40 years, when monthly periods stop and estrogen level is low, which causes menopausal symptoms. The cause for POF includes autoimmune conditions or genetics. POF can be permanent, temporary or periodic and there may be residual ovarian function. Some women with POF may intermittently produce estrogen and even ovulate spontaneously or with the help of potent fertility drugs. Our doctors will guide you on the options for fertility treatment.

Following are the reasons for requiring a donor egg:

Age more than 40 years

High level of FSH hormone

No ovaries

Premature ovarian failure

Previous IVF failure

Benign or malign formation on ovaries [increased level of oncomarker Ca-125]

Genetic disease

WHO [World Health Organiszation] has established six semen parameters for semen analysis and they are:

sperm concentration


overall motility



total motile count

High level of stress in women may cause disturbances of ovulation, and in men impaired sperm production. Stress reduction will help to cope up with infertility. Suggestion for stress reduction will be open talk with partner, exercising regularly , stress relieving activities such as yoga or meditation , avoiding excessive intake of caffeine or other stimulants and to take emotional support from relative or friend.

Pre cycle tests are some blood tests and scanning, which can be done at any infertility clinic with minimal discomfort. Once you are already to start the IVF process you have to take few medicines and injections. Injections are administered subcutaneous with a short needle and discomfort should be tolerable. Only progesterone injections are given intra muscularly.

The main procedure involved in IVF is the egg retrieval and this is performed through the vagina with ultrasound and a fine needle. Patients at our centre are asleep during this procedure and are cared for by a team of anaesthesiologists. Patients have no pain with this procedure and they wake up very quickly with the egg retrieval lasting 10-15 mins. The embryo procedure is again a very simple one. A very light anaesthesia is required when there are specific problems with the cervix.

There is no question that the whole process of infertility represents a tremendous loss of control over what should be basic function and this causes initially denial, then anger and depression. At our centre we have trained counsellors you can talk with them during the early stages of your IVF cycle, so that you may best use certain practices and procedures to cope with the stress of assisted reproduction. It is impossible to eliminate stress completely and each of us needs a certain amount of stress in our lives to keep us vital. The important factor is our response to this stress and we need to learn coping strategies which prevent us from reacting in a way that is detrimental to the whole aim of therapy which is to establish and nurture a pregnancy.

A female foetus starts out with more than one million immature eggs and this number decreases steadily so that at the time of puberty, there are approximately 200, 000 eggs remaining in the ovaries for future ovulation. Many eggs are recruited each month but in a natural cycle only one egg matures. Menopause refers to the time when all viable eggs have been used up and this generally occurs in the mid to late 40S. The biological clock therefore refers to the time starting with puberty and ending with menopause during which the number of eggs decreases steadily. As a women approaches menopause, the ovaries become more resistant to stimulation producing fewer eggs that they did in the years before. For some women this ovarian resistance can start in the 30s and even occasionally in the teens and early 20s. There are number of ways of estimating ovarian reserve – the most common is to measure the FSH and LH on the second or third day of the menstrual cycle. An FSH level over 10 suggests the onset of ovarian resistance.

For women above forty years chances of getting pregnant by their own egg decrease if the base line FSH is less that 11 miu/ml. Secondly, their embryos need assisted hatching to increase the chances of implantation. Lastly, but most important, women above 40 should go for Pre Implantation Genetic Diagnosis (PGD) as at these age higher percentage of chromosomal abnormalities and mutation in gene observed. The other simple and safe option is “egg donation” by any younger lady.

Endometriosis is a condition where cells that usually remain confined to the cavity of the uterus, grow outside of the uterus usually on or in the ovaries and also on the surface of the pelvis. It causes pelvic pain and may also decrease the chances of natural conception by about a third. Patients who require IVF who have endometriosis still have the same chances of a successful outcome as patients of the same age without endometriosis as long as immunological factors that may accompany endometriosis are identified and treated appropriately

Fibroids are benign tumours consisting of fibrous tissue and muscle which grow in the uterus. The significance of fibroids relates to not only their size but also their location. Even small fibroids located inside the cavity of the uterus where embryos need to implant, may interface with success and need to be removed. Fibroids that do not encroach on the cavity of the uterus are generally not significant unless they are larger than 5 cm in diameter and also if there are many fibroids causing significant uterine enlargement.