2.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. In a study conducted at our Fertility Centre for past 4 years Endometriosis has been found to be cause in 28% of female causes of infertility. The cause of high incidence of endometriosis is not clear but may be due to environmental pollutants like Dioxin caused by burning plastic materials.

3.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. Centres equipped with most modern gadgets required for key hole surgery. 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.

4.How does Polycystic ovary cause infertility? What is its Management?
During a four study period from 1997-2001 it was found that Polycystic ovary was the leading causative factor in female infertility in over 37% cases. These patients are obese and have irregular periods and may be associated with increased hair growth.

Assistance may be given to achieve pregnancy by pr 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.

5.What is Sperm washing (I U I) ?
When conception does not occur normally, Intrauterine insemination is carried out which involve drugs for Follicular Stimulation anollicular Stimulation and Ovulation Induction. When ovulation occurs the sperm sample is carefully washed and is placed high in the uterus. The treatment is carried out for 4-5 cycles and success rate is 20% in one cycle.

6.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 in to 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 is around 40%.

7.Semen banking .Is it available in Kerala ?
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.

8.What are the types of surgery done via Laparoscope?
Diagnostic Laparoscopy help 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.

9.What is Hysteroscopy? why is it done?
Hysteroscopy is important in the study of Infertility, recurrent miscarriage or abnormal uterine bleeding. Diagnostic huysteroscopy 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.

10.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.

11. 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 tests like IUI can cost over Rs.1000 in one sitting. The cost of Operative Laparoscopy is around Rs.12,000-15,000.IVF cycles cost the patient around Rs.85,000-90,000 depending on the use of costly medicines.

12. Blastocyst culture (day 5 transfer) or day three transfer? Which is advisable?
Day 3 transfer of embryo is better than Day five transfer (blasto cyst culture). As 30-40% of embryos fail to grow beyond day 3 and various studies haven’t shown.