Frequently Asked Questions
No. You will spend over an hour with the doctor during your first consultation. We carefully assess the cause of your infertility and decide on the simplest possible treatment that can give you a pregnancy. The choice of treatment depends on the cause of infertility, baseline hormone levels and the woman's age.
The number of eggs produced is influenced by a number of factors like patient's age, diagnosis for infertility, stimulation protocol, type and the dosage of the drugs used, individual response to medication. There is often cycle variation too for ovarian stimulation. We optimize our stimulation to get about ten eggs.
The medication used for ovarian stimulation are the same gonadotrophins that are naturally produced by the anterior pituitary gland situated in the brain. We can regulate the dosage of these to get the required response from the ovary.
No. It is a minor procedure which s done as a day case. The eggs are collected through the vagina by using ultrasound guidance. A long needle is guided through the top of the vagina into the follicles in the ovary that contain the eggs. There are no cuts or incisions on the abdomen. The procedure is done under light general anaesthesia so there is absolutely no pain.
Not all the eggs that are harvested are fully mature. Immature eggs do not fertilize. However some of these eggs could also be matured in the laboratory under special conditions. The average fertilization rate for good quality eggs is 80%. Some eggs may be chromosomally grossly abnormal. These also may not fertilize. So the fertilization rate will depend on the quality of the eggs and the sperms.
Normally, only 95% of the normal good quality fertilized eggs (zygotes) will divide to 2 and 4 cell stage in the first 48 hours.
Only 30-50% of the embryos have the potential to grow to more advanced stage called the blastocyst by the 4th and the 5th day. There are many variable factors which can affect this like patient's age, diagnosis of infertility, quality of eggs, sperm and embryos. Sometimes none of the embryos will reach blastocyst stage resulting in cancellation of embryo transfer. The culture conditions also affect the blastocyst development.
Estimated range of normal embryo development per day
- Day 0 :Egg collection
- Day 1 :Egg fertilization ( 2 PN, Zygote, single cell stage)
- Day 2 :2-4 cell stage
- Day 3 :6-8 cell stage
- Day 4 :8 cell stage, morula
- Day 5 :Early blastocyst to expanded blastocyst
- Day 6 :Blastocyst to hatching
Yes, when the normal healthy embryos are in the appropriate developmental stage on time they could be frozen by vitrification. Poor quality embryos or under developed embryos will not be frozen.
Once the eggs, embryos or the sperm are frozen, they can be kept indefinitely in the liquid nitrogen. The quality of the gametes does not change by freezing process. We have put embry back after 15 years freezing and produced a healthy baby.
But in practice we keep frozen gametes for only five years. The reason for the limited period is, the socioeconomic circumstances change and you may no longer want your gametes frozen. It is necessary you constantly keep in touch with the Centre and pay the appropriate annual fees for safe keeping of your gametes.
We try to keep in touch with the couple on a yearly basis. If on repeated attempts to contact we fail then the centre has no alternative but to remove the embryos from cryo storage and allow the embryos to perish.
A very strict double identification and witnessing procedure is in place in our andrology and embryo laboratory. We follow the guidelines recommended by the Human Fertilization and Embryology Authority (HFEA) of United Kingdom for handling the gametes. Only one patient's gametes are handled at any time. Thus human error is limited. Here are some of the procedures in place in our Centre:
Only one patient's sperm sample, eggs or embryos are handled and processed at time. Only one person will handle one patient's samples. All the dished, pipettes, test tubesthat are used are disposable hence used for one patient only, discarded and NEVER reused.
Every patient's sperm sample, eggs and embryos for each patient are labeled twice by name and a number. The patient's name and identification number is unique for each patients. At each step there would be witness for these identification process. Either a member of the clinical staff, laboratory staff ( doctor / nurse / laboratory staff) must verify the identity of the patient versus the labeled dish before the embryo transfer is performed. You must understand that these procedures are taken very seriously by all the staff. Due to the very strict adherence to these procedure only authorized clinical personnel from the Miracle Advanced Reproductive Centre (MARC) are allowed to the operating theatre and the laboratories.
The side effects of the drugs used in fertility treatment could be summed up under two headings. One immediate side effects and two, late side effects.
The immediate side effects are local reaction to the drugs like swelling, redness, itching and anaphylactic shock. However due to the purity of the drugs we use these reactions are very rare. Some of the medications (analogues) can give rise to hot flushes, mood swings, restless sleep, fluid retention, headaches and menopausal symptoms. The intercourse could also be uncomfortable or painful. But these symptoms are only temporary during the administration of these medications.
The most dangerous and serious side effect is Ovarian Hyper Stimulation Syndrome. (OHSS) This most likely to happen in cases of Polycystic Ovaries. Here in spite of our careful evaluation of the dosage of the stimulation drug the ovaries respond excessively and produce large number of follicles. The ovaries become large, painful, produce fluid in the abdomen and cause salt imbalance in the blood resulting in kidney failure. This can happen in 2-3% of the cases. We take great care in preventing this event.
The long term side effect some times attributed to the stimulation drugs is cancer. Even though we have been using these drugs from early 60s there is no proven relationship between ovarian stimulation and cancer of ovaries, breast, uterine lining or bowel. But the time frame of duration these drugs have been used is still relatively short. We carefully monitor every stimulation and do not initiate unless we are doing the most appropriate treatment. We also go carefully through your history to see if there is any strong cancer history in each case. In summary no direct link has been established between the use of hormones and cancer.
Because we used to put three embryos in IVF treatment cycle we used to get around 10% chances of twin pregnancies and 3% chances of triplet pregnancy. Since the number of embryos was reduced in the last 7-8 years the twin incidence was reduced to around 5% and triplet pregnancy rate was reduced to <1%.
We carefully assess each case for age, cause of infertility, quality of eggs, sperm and embryos and then decide how many embryos we want to replace. We also discuss this with every patient before embryo transfer. In young, with previous pregnancy and very good quality embryos we only replace one embryo and freeze the remaining embryos. Thereby reducing the risk of multiple pregnancy.
The risk of an extra uterine pregnancy (ectopic) is around 2.5%. We have been unable to reduce this though we can diagnose ectopic pregnancy at a very early stage before it ruptures and treat it either but chemotherapy or by surgery.
The overall success rate in unselected cases is around 35%. But if one breaks down these figures the in women under the age of 38 the pregnancy rate is 45%. Between 38-40 the pregnancy rate is 28%. After 40 the pregnancy rate is around 10%. Basically pregnancy rates depend on the woman's age, cause of infertility, stimulation protocol, quality of eggs, sperm and embryos. The pregnancy rates quoted are for a woman using her own eggs. In our experience, someone using donor eggs from a young donor, the pregnancy rate immaterial o the recipient's age is over 50%.
We normally estimate the pregnancy rate for each patient and tell them at the time of consultation. So one should not get carried away by the high pregnancy rates quoted by other centres as these are in highly selected group of patients.
Other risks of fertility treatment are bleeding and infection. The ovaries have very close proximity to the big blood vessels in the pelvis. But due to the very sophisticated ultrasound machines we use, we can keep well away from these blood vessels. However sometimes there is small amount of bleeding from the vaginal wall where the needle has pierced to enter the ovary. This bleeding is very small and very easily controlled before every operation is finished.
The other risk is infection. There is no way to render the vagina completely sterile. The needle has to pass through the vagina before it enters the ovary. We always give a prophylactic (preventive) course of intravenous antibiotic during the course of the operation. Unfortunately the risk is higher in cases of endometriosis due to the presence of old blood in the pelvic cavity. Due to the administration of antibiotics during the course of the operation the risk has been markedly reduced.
Yes. All the information you give us at the consultation, treatment and any other time is documented in your notes but remains in the Centre. Except the people working in the Centre and directly involved in your treatment will have access to your records. The notes are not permitted to be taken outside the Centre. If anybody requests any information about you it will only be given to them after you have signed a consent that such information could specifically given to named hospital, clinic or other institution.
Only your referring doctor will have a letter to the effect that your treatment will be done at the centre. So you can be sure that any information you give will be confidential and will not be given to even your relatives!
Yes. You will be informed of the progress in tour treatment at every stage. If there are any setbacks in the treatment this also would be discussed with you. So you are aware of all the aspect of your treatment. We are normally in constant touch with you during the treatment cycle. You will have access to see a doctor every time you come to the Centre.
There is mathematical formula to decide on the dosage of medication you need for the treatment. It is dependent on the age of the woman, body mass index, the treatment method and cause of infertility.
If it is IUI we give very small amount of stimulation to get one or two follicles only. For IVF the dosage is adjusted to get about 8 to 10 follicles. But the ovarian response is unpredictable in different women and in the same woman in different cycles.So if the ovarian response is not we want then the cycle may be cancelled and a different dosage and / or medication will be tried in the subsequent cycle.
Not necessarily. If you feel that you under lots of stress with the fertility treatment, if you are using donor eggs or donor sperm, if you are using surrogacy to get a baby, if you had several treatment cycles without getting pregnant or had a baby with abnormalities, then you must have counseling. We use an independent counselors ad you have to pay them get support counseling or therapeutic counseling.
Some of the treatments are acceptable but some others are not. So it is always better to discuss this with the us before you start your fertility treatment at the Centre.
No. When you come for consultation please bring all your reports, copies of your investigations etc with you. If you do not have copies, please ask your doctor to do a medical report about your tests and previous treatments. We will scrutinize all your reports etc and carefully document them. We will not unnecessarily repeat your tests. So we do only investigations that are necessary and those which are going to help in planning your treatment. We will explain to you each test in detail so you also understand the result of each test you have done.
No. Once you have had your consultation we will programme your cycle with hormone tablets to get your menstruation at certain time. Then we will start the stimulation on day 2 of the cycle. There may be variation in your treatment protocol as each woman's protocol is tailor-made for her problems. The reason for programming the cycle to get the culture media etc are fresh for your treatment. Most of the media has a shelf life of only six weeks. But we want to do your treatment when the culture media is less than two weeks old so that it is at the optimum quality during your treatment.
We also promise you that we see you by appointment and you will not be kept waiting more than 30 minutes from your appointed time. If you waited more than 30 minutes then you will not charged for that appointment!