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What is infertility?
Infertility is the inability to conceive after a year of unprotected intercourse
in women under 35 and after six months in women over 35. Couples who have known
barriers to fertility, such as endometriosis, polycystic ovarian syndrome, male
factor infertility, irregular cycles, etc., do not need to sit out the traditional
waiting period to seek expert care for infertility. [back]
How common is infertility?
One in every six couples of childbearing age have an infertility problem. There
is a female problem in 35% of the cases, a male problem in 35% of the cases, and
a combined problem of the couple in 20% of cases. Therefore, it is essential that
both the man and the woman be evaluated during an infertility work-up. In 10% of
cases, the problem is "unexplained", meaning that all testing yielded normal results.
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When should I seek help for infertility?
Conventional medical advice is to seek treatment if you have been trying to conceive
for at least one year. However, if the male partner has a known or suspected low
sperm count or the female partner is over 30 years old, has a history of pelvic
inflammatory disease, painful periods, recurrent miscarriage, or irregular periods,
then we suggest you seek treatment sooner. [back]
What are "primary" and "secondary infertility"?
Primary infertility is infertility without ever conceiving or successfully carrying
a pregnancy to a live birth. Secondary infertility is the inability to conceive
again after one or more successful pregnancies. [back]
Why is there a declining trend for Seminal Parameters in
Male?
Male Infertility is one of the largest causes of subfertility. There is a declining
trend for seminal parameters throughout the world. The stress associated in this
highly competitive world ,environmental pollutants, smoking, Varicocoele and sexually
transmitted diseases are the causative factors. Lack of exercise, prolonged rides
in motorbike, tight jeans and undergarments are also attributed as causative factors
for male infertility. [back]
What are the common causes for female contributing to infertility
in Kerala?
The reasons of female infertility may be due to failure to ovulate, obstruction
to fallopian tube, infections such as pelvic inflammatory disease due to tuberculosis
or sexually transmitted diseases. In Kerala there is a high incidence of endometriosis.
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What are the advantages of key hole surgery over open surgery?
Is it costly?
Laparoscopic Surgery (Key hole surgery) which is minimally invasive surgery is the
appropriate method of treatment. Advantages are that it is minimally invasive –
only 3-4 small key hole size incisions are made. The patient can be discharged within
24 hours and can try for conception immediately. The other advantage is the time
taken to resume normal activities is less than 2 weeks when compared to 4-6 weeks
rest advised in Laparotomy(Open Surgery). The cost of laparoscopic surgery is equal
to open method. [back]
How does Polycystic ovary cause infertility? What is its
Management?
Polycystic ovary was the leading causative factor in female infertility in over
30 – 40 % cases. Egg development does not occur in patients with polycystic ovaries.
These patients are often obese and have irregular periods and may have increased
hair growth. Assistance may be given to achieve pregnancy by proper medications,
measures taken to reduce weight and monitoring ovulation by Ultra sound Doppler
study and estimation of hormones. The estimation of hormones is by highly sensitive
Elisa method. To optimize the chances for conception an ovarian stimulation protocol
is followed which aid growth of follicles and bring about ovulation.
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What is Sperm washing (I U I) ?
When conception does not occur normally, Intrauterine insemination is carried out
which involve drugs for Follicular Stimulation and Ovulation Induction. When ovulation
occurs the sperm sample is carefully washed and is placed high in the uterus by
means of a catheter. The treatment is carried out for 4-5 cycles and success rate
is around 14 % in one cycle. [back]
What is the need for doing ICSI in In-vitro fertilisation
cycles ?
A number of patients undergoing IVF fail to achieve fertilisation where the sperm
is unable to penetrate the outer shell of the egg. ICSI is used to help men with
severe sperm impairment. By directly injecting the sperm into the Cytoplasm of the
egg the natural barriers that the sperm encounters are bypassed. ICSI is indicated
when the semen parameters are suboptimal, Previous failed fertilisation in IVF and
in Unexplained Infertility. The success rate around 30 – 35%.
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Semen banking .Is it available in the hospital?
Semen banking is available in our hospital. Most of semen samples can be frozen
for long periods (Sperm Cryopreservation) and thawed without loss of fertility.
Sperm Cryopreservation is indicated prior to vasectomy, husbands working in gulf
countries and Donor Insemination and these samples are thawed prior to insemination. [back]
What are the types of surgery done via Laparoscope?
Diagnostic Laparoscopy helps to diagnose many gynaecological problems including
endometriosis, Uterine fibroids and other structural abnormalities, Ovarian cysts,
adhesions (scar tissue) and ectopic pregnancy. Many infertile patients require laparoscopy
for complete evaluation. If defects or abnormalities are discovered, diagnostic
laparoscopy can become operative laparoscopy. During operative laparoscopy, many
disorders can be safely treated through the laparoscope with the aid of camera connected
to the monitor.. Removing adhesions from and around the fallopian tubes and ovaries,
opening blocked tubes, removing ovarian cysts, removal of endometriosis from the
out side of the uterus, ovaries, or peritoneum. Under certain circumstances, fibroids
on the uterus can also be removed. Operative laparoscopy can also be used to remove
diseased ovaries and can assist in the performance of hysterectomy.
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What is Hysteroscopy? why is it done?
Hysteroscopy is important in the study of Infertility, recurrent miscarriage or
abnormal uterine bleeding. Diagnostic hysteroscopy is used to examine the inside
of the uterus. And is helpful in diagnosing abnormal uterine conditions. Operative
hysteroscopy can treat many of the abnormalities found during diagnostic hysteroscopy.
Fibroids, Scar tissue, and polyps can be removed from inside the uterus. Congenital
abnormalities, such as a uterine septum, may also can be corrected through hysteroscope. [back]
Is scanning harmful?
Scanning is not harmful as it is the sound waves under high frequency passed and
the reflected beam is seen in the monitor. No harmful effects on foetus or mother
has been reported after multiple scanning. [back]
Is infertility treatment costly ?
A basic evaluation of the male and female helps to identify who is at fault. It
is not a costly treatment but sophisticated procedures like IUI can cost over Rs.2000
in one sitting. Cost of laparoscopy is around Rs35,000. IVF cost varies according
to requirement of medicines and procedure done. [back]
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