If a couple is planning for a family, and either of them is diagnosed with any of the above conditions or other than these, he/she has to consult a fertility expert. This expert will advise the best possible treatment available to carry forward their journey. IVF treatment is a complicated process. It is very important for a couple to understand all its aspects, what they can expect from IVF and to clear the misconceptions related to it. The counsellor reviews the history of the couple, and accordingly guides them with the treatment options which are most appropriate for them. He also helps them to understand the process, especially during critical cycles, duration of the procedure and complications that may be related to it. Fertility counselling is an opportunity for a couple to discuss the emotional difficulties, anxiety, fear that they may face during the journey. The counsellor not only counsels about the medical treatment but helps the couple to make their journey easy in all the aspects.

There are certain tests which an individual has to undergo before heading for any assisted reproductive techniques. Fertility Investigation tests for male :

Ovulation is the process in which the egg is released from one of the ovaries. This happens approximately once in a month in women with regular menstrual cycle. This process is irregular, rare or totally absent in some women, as their follicles which hold the egg do not mature regularly. Ovulation Induction is the fertility process in which oral or injectable medicines are given to stimulate the ovulation. The medicines are given from the second day of menses. It increases the size and number of follicles. The medications and dosages to induce ovulation are tailored to suit the individual. Ultrasound is done on alternate days from ninth day onwards to check the body’s response. When the follicle reaches around 18-20mm in size, the trigger is given which helps in ovulation. The clinician can then see when the female is due to ovulate and therefore the best time for intercourse or insemination.

It is a type of artificial insemination, used to treat fertility disorders. This is the process in which the sperm from the partner or the donor is directly released into the uterine cavity. It is done around the time of ovulation.

During natural conception, sperms travel from the vagina through the cervix, into the uterus, and up to the fallopian tubes. With IUI, sperm sample is prepared and concentrated, and placed directly into the uterus, which puts them closer to the egg.

In this procedure, the best quality sperms are chosen from semen sample. The sample will be washed in a way that separates the highly active, normal sperm from lower quality sperm and other elements. Most of the IUIs are done a day or two after detecting ovulation, for the sperm to fertilize with the released egg. Depending on the reasons for infertility, the timing of IUI can be coordinated with normal cycle or with fertility medications.

The treatment is recommended for -

• It is the right choice of treatment when the male partner is diagnosed with some fertility disorder like low sperm count, reduced motility, abnormal morphology of the sperm, erectile dysfunction.
• Endometriosis related infertility - For infertility related to endometriosis, using medications to obtain a good-quality egg along with performing IUI is often the first treatment approach.
• Cervical factor infertility -Some cervical abnormalities can restrict the entry of the sperm into the uterus. The thickened cervix can prevent sperm from reaching the egg and thereby reducing the chances of conception.
• Age - Fertility experts prioritize the IUI process to treat the age related infertility.
• Donor sperm -For women who need to use donor sperm to achieve pregnancy, IUI is most commonly used. Frozen donor sperm specimens are obtained from certified labs and thawed before the IUI procedure.

Duration of the procedure -

The procedure is done in a hospital, performed by IVF expert and specially trained nurse. It takes around 15 to 20 minutes. The IUI procedure itself takes around a minute or two and requires no medications or pain killers. The patient can get back to his normal daily activities on the same day after a short rest. Some light spotting can be observed in next two days after the procedure.

Results of IUI -

After two weeks of the procedure, the at-home pregnancy test is done. The doctor may instruct to return in about two weeks for a blood test, which is more sensitive in detecting pregnancy after fertilization.

It is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child. In vitro fertilization, that is the test tube baby, is the procedure in which the fertilization is achieved outside the uterus. It is the most commonly used procedure to help couples facing fertility issues.

The procedure starts with monitoring the women for ovulation. The matured eggs are removed from the ovary. The frozen semen sample from the laboratory is prepared and it is allowed to fertilize the eggs in a culture medium in a laboratory. Once the egg is fertilized, and embryo is formed, it undergoes embryo culture for 2 to 6 days. Embryo is then implanted into the uterus to establish a successful pregnancy.

IVF is the most effective form of assisted reproductive technology (ART). The procedure can be done using a couple's own eggs and sperm or it may involve eggs, sperm or embryos from anonymous donor. In some cases, a gestational carrier — someone who has an embryo implanted in the uterus — might be used.

The treatment is recommended for -

• As a primary treatment option for the women above the age of 40 years.
• Damaged/blocked fallopian tube - If the fallopian tube is damaged or blocked, it is difficult for a egg to be fertilized and for an embryo to reach the uterus. In such cases, the technique is used and embryo formed in the laboratory is implanted in the uterus.
• Ovulation disorder -If the ovulation is irregular or rare, the menstrual cycle is monitored and the matured egg is retrieved for the IVF. If the ovulation is totally absent, donor oocyte can be used for the IVF process in order to achieve the pregnancy.
• Cervical factor infertility -Some cervical abnormalities can restrict the entry of sperm into the uterus. The thickened cervix can prevent sperm from reaching the egg and thereby reducing the chances of conception.
• Endometriosis - It is a condition in which the tissues lining the uterus grow outside the uterus causing infertility in females. This can be treated with the technique of IVF.
• Genetic disorders -If any of the partner has a genetic disorder, which may be transferred to the child, then the IVF can be done along with other genomic procedures. The formed embryos are screened for the known genetic disorders. The embryos that do not have the identified genetic disorders can be transferred to the uterus.

Duration of the procedure - IVF involves several steps — ovarian stimulation, egg retrieval, sperm retrieval, fertilization and embryo transfer. One cycle of IVF procedure takes around 2 to 3 weeks. More than one cycle may be needed.

The Procedure

Ovarian stimulation -The cycle begins by using hormones or medication to stimulate ovaries to produce more eggs. Multiple eggs are required to increase the chances of fertilization. Generally, one or two weeks of ovarian stimulation is required before the eggs are ready for retrieval.

Egg Retrieval -It is done at the hospital, 36 hours after the final stimulation and before ovulation. The procedure can take around 20 minutes. Transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into patient’s vagina to identify follicles. Then a thin needle is inserted under ultrasound guidance to go through the vagina and into the follicles to retrieve the eggs.

Sperm retrieval - The semen sample from the male partner needs to be provided at the hospital on the day of egg retrieval.

If it is not possible to collect the sample by natural means, for example in cases like azoospermia (absence of sperm), several techniques are used for sperm retrieval.

Testicular Sperm Aspiration (TESA) And Percutaneous Epididymal Sperm Aspiration (PESA) -

If the hormonal profile is normal, in cases of obstructive azoospermia (absence of sperm), sperms can be aspirated through the testis or epididymis. It can be done under local anaesthesia. Sperms are separated from the semen sample. Donor sperms can also be used.

Fertilization - The retrieved sperm and eggs are kept together under laboratory conditions for fertilization.

There are two methods by which the fertilization is performed -

• Conventional Insemination -
• Intracytoplasmic Sperm Injection (ICSI) - It is the procedure in which the healthy sperm is directly injected into the cytoplasm of the egg.

Once the eggs are kept for fertilization, the next day, the embryologist will examine the eggs for fertilization and later on for further development of embryos. If there are more than three well developed embryos, it is possible to freeze them for a later transfer, if necessary.

The embryos are allowed to develop in incubator until they are ready for implantation.

Before the embryo gets transferred, there are certain procedures which may be required.

• LASER Hatching - If the outer shell of the embryo, i. e. blastocyte is tough, laser hatching is done on it when it reaches to day 5. It increases the chances of implantation and allows that embryo to implant into the uterus. That’s why laser hatching is advised to patient who have had more than two IVF (implantation) failures.
• Genetic Testing - A small sample of the embryo is taken and tested for specific genetic disorders or to correct the number of chromosomes, typically after day 5 or day 6. This reduces the chances of transmission of genetic disorder from parent to child.

Embryo Transfer - About three to five days after fertilization, the embryos will be placed in the uterus using a catheter. Embryos get settled in the lining of the uterus and begin to develop. Like other processes, this part of IVF is performed in hospital while the mother is awake.

Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less-developed embryos (day two or three). However, not all embryos survive the development process. Hence more than one embryos are transferred.

A pregnancy test is done after 12 - 14 days of egg retrieval. If the test comes positive, the woman is further referred to an obstetrician for prenatal care.

To fertilize the egg, the sperm’s head has to get attached to the outer shell of the egg. From there the sperm cell will go inside of the egg, i.e. cytoplasm, where the fertilization will take place.

In cases of infertility, sometimes this outer layer of the egg is thick which makes it hard for a sperm to penetrate through it. In other cases, low sperm motility can be the cause for sperm being unable to reach the egg’s outer layer.

In such cases, intracytoplasmic Sperm Injection (ICSI) is done along with IVF, in which a single healthy sperm is injected directly into the cytoplasm of the egg. Once the egg is fertilized with the injected sperm, the further steps of IVF procedure are followed.

It is a more sophisticated way of performing ICSI procedure. In this process, the sperm is selected under higher magnification. This allows the sperm to be examined in greater detail, including the nucleus which contains the sperm's genetic material. Use of this method has resulted in higher pregnancy and delivery rates and lower abortion rates

In certain fertility disorders, where it is difficult to achieve the pregnancy by the sperm and the egg of the couple, donated oocyte or semen can be used. The identity of the donor is kept completely confidential. The process is completely legal and done with the consent of the couple.