Revolutionary treatment for male sperm related infertility that involves injecting single healthy sperm into mature egg followed by placement of the fertilized egg into the women's womb. It is one of the assisted reproductive technology that helps an infertile couple to bring a healthy baby into this world. It is paramount that each couple should take consultation and undergo thorough examination to determine, along with their specialist, the most appropriate treatment method that will bring about good results. Since fertilization of egg takes place outside the woman's body, it is considered as a form of IVF (In vitro fertilization). It is regarded as one of the best male infertility treatment.
Q1. What is Infertility?
A1 Inferility is defined as the inability to conceive even after one year of regular(once in every 2 to 3 days) unprotected sex i.e., without utilizing any method of contraception. According to statistics, generally around 85% of the couples conceive within an year of regular unprotected sex, however, in United Kingdom, infertility is only diagnosed if there is an inability to conceive even after 2 years or 24 months of regular unprotected sex, without contraception. According to the data provided by National Health Service, UK, 95% of the couples will conceive by 2 years. Infertility may be due to innate inability of one of the partner to contribute his/her bit in conception or even when the female is not able to carry the pregnancy to the full term.
Pregnancy happens when:
Egg or ovum (female reproductive cell) is released by one of woman's ovaries.(Ovulation)
Sperm or male reproductive cell unites with ovum.(Fertilization)
Fertilized egg travels through the fallopian tube until it reaches the uterus(womb).
Fertilized egg adheres to the uterine wall.(Implantation)
Problem with one or more of the above milestones in the pregnancy process, may result in infertility.
Q2 What are the types of infertility?
A2 There are mainly two types of infertility.
Primary Infertility: Primary Infertility term is used for the couples who have not been able to conceive at least once, even after an year of regular unprotected sex, without contraception.
Secondary Infertility: Secondary infertility term is used for the couples who were previously able to have their own, one or more biological child/children naturally but are inable to conceive now or carry the pregnancy to the full term.
Q3 I have a child. However, I am not able to conceive again. What could be the reason?
A3 Secondary infertility, which seems to be your case, may be caused by the following:
Problem with the formation, function and delivery of sperms.
Disorders of fallopian tube, uterus
Problem with the Ovulation
Complications associated with previous surgery or pregnancy
Could be as a result of certain medications
Q4 What makes a man vulnerable to development of infertility?
A4 The several factors that makes a man vulnerable to development of infertility can be summarized as follows:
Obesity or being overweight
Age also to some extent, though not as important a factor as in females
Excessive alcohol intake
Increased exposure to radiation, high temperature, environmental toxins
Side effect of certain medications
Q5 Is infertility only a woman's problem?
A5 Its purely a misconception that women are the only ones who are responsible for infertility. Its imperative to make it clear that man and a woman have their own respective parts to play in conceiving a child and anyone of them or both may be responsible for the infertility.
Q6 What are the causes of male infertility?
A6 There are several causes responsible for male infertility. Semen analysis is carried out initially to determine whether male factor is responsible for infertility and if yes, then how and accordingly further course of action is planned by the specialist. Semen analysis looks into the appropriate concentration of sperms(number), their functional capacity(motility) and their structure(shape). The responsible causes of male infertility work by affecting sperm production, their quality (structure,motility,viability) and delivery. They can be summarized as follows:
Impaired testicular function or ejaculation
Varicocele(abnormal enlargement of veins in the scrotum, the loose bag of skin in which the testes are present). It causes the testes to overheat which not only leads to low sperm production but also adversely affects their quality.
Injury to the testes
History of Undescended testicles or cryptorchidism
Indiscriminate use of alcohol,excessive smoking, use of anabolic steroids or use of illicit drugs are some of the detrimental habits.
Certain medications or summplements also adversely affects the male fertility.
May be a result of cancer treatment such as chemotherapy, radiation therapy or surgical treatment that involves removal of one or both the testicles.
Certain medical conditions may adversely affect testes such as Diabetes, Cyctic Fibrosis, some autoimmune disorders and infections such as Gonorrhoea, Chlamydia.
Sperm delivery is compromised due to
Disorders of hypothalamus and pituitary gland leading to impaired testicular function. Prolactin secreting Pituitary tumor leads to increased production of hormone Prolactin, a condition referred to as Hyperprolactinemia which causes loss of libido, impaired sperm production, impotence. Hypothalamus and Pituitary gland in the brain produce hormones that are responsible for the normal function of the testes.
Congenital adrenal hyperplasia
Klinefelter's syndrome, Y chromosome microdeletion are some of the genetic disorders that result in low or no sperm production.
Q7 What are the causes of infertility in woman?
A7 Female infertility can be attributed to the disorders of one or more of the following:the ovaries, fallopian tubes and uterus.
They need to be healthy and fully functional. The causes can be summarized as below:
Impaired ovarian function wherein release of the egg from the ovaries(ovulation) is affected. It may be due to
Polycystic Ovary Syndrome(PCOS): A medical condition characterized by development of several fluid filled sacs(cysts) in the ovaries. It is one of the most common reason for female infertility and is treatable. It is associated with hormonal imbalances leading to anovulation or irregular ovulation (release of eggs from the ovaries) indicated by irregular or no periods, weight gain, fertility issues and depression. It is also associated with increased level of male hormone (testosterone) responsible for acne, excess hair growth(hirsuitism) and hair thinning on the scalp.
Diminished ovarian reserve (DOR): Every women is born with all the eggs she will ever have in her lifetime. As she ages, the number of eggs decrease naturally. However, there are various other congenital, medical, surgical or unknown causes responsible for abnormally low number of remaining eggs in the ovaries. As the condition's name implies, diminished ovarian reserve means that there are less number of eggs left in the ovaries. Women with DOR may conceive naturally, however, their response to the fertility treatment may result in production of less number of eggs.
Functional Hypothalamic Amenorrhoea (FHA), a condition resulting from a lot of exercise, stress or extremely low body weight. It sometimes accompany eating disorders such as anorexia (loss of appetite).
Inefficient functioning of hypothalamus and pituitary gland in the brain- Hormones released by hypothalamus and pituitary gland are responsible for the normal function of ovaries and release of eggs from them. However, in a medical condition Hyperprolactinemia, which is characterized by high production of hormone prolactin from the pituitary gland, woman may not ovulate.
Premature Ovarian Insufficiency (POI), also referred to as Premature menopause, wherein ovaries stop functioning even before 40 yrs of woman's age i.e., far earlier than the age when normal menopause sets in. Although there are certain conditions that makes a woman susceptible to POI, such as chemotherapy or pelvic irradiation exposure or certain medical conditions. Usually the cause is unknown.
Menopause, a normal phase of woman's life that sets in around 50 yrs of her age and is characterized by normal decline of ovarian function, hormones estrogen and progesterone are no longer produced by the ovaries and cessation of menstruation or periods. Once menopause begins, she is no longer able to conceive naturally. Menopause is considered to have set in if periods have not occurred for one whole year.
Fallopian tube obstruction: A pair of thin and long muscular tubes in the abdominal cavity of the woman that extends from the ovaries to the uterus. Fully functional,normal, open and unobstructed fallopian or uterine tubes are paramount in successful spontaneous reproduction. They play a significant role in transport of reproductive cells(ovum and sperm), provide favorable environment for fertilization of egg and early embryo development. There are various tubal elements that come into play to make the tube work efficiently. They are rhythmic muscular contraction of the tube, ciliary function(thin hair like projections on the inside of the walls of the fallopian tube) and tubal secretions. History of pelvic infection, abdominal surgery, ruptured appendicitis, Chlamydia or Gonorrhea infection or endometriosis may point towards tubal blockage or occlusion.
Uterus disorders such as uterine fibroids that distort the uterine cavity and make it difficult for implantation to take place. However, they are treatable. Scarring or adhesions within the uterus or malformation of the uterus are some other causes for female infertility.
Q8 What are the treatment options for infertiity?
A8 Infertility can be treated with the administration of medicines, surgery, IUI (Intrauterine Insemination) and ART(Assisted Reproduction Technology). Several factors are taken into account before determining the best treatment protocol for the couple. The factors are:
Cause of the infertility
Duration of infertility
and the couple's treatment method preference
Normally, thorough evaluation and counselling are done regarding viability, pros and cons of each treatment option, their success rates before reaching the final treatment decision after mutual consent.
Q9 What is ART(Assisted Reproduction Technology)?
A9 ART or Assisted Reproduction technology or treatment, as the name implies, refers to the use of technology in order to assist in achieving pregnancy. ART or Assisted Reproduction technology encompasses broad range of fertility treatments such as:
IVF (In vitro Fertilization): The most common and most successful form of ART, which refers to fertilization that takes place outside the woman's body, in a laboratory. The egg from the female partner and the sperm from the male partner are procured and united in a laboratory and the resulting embryo after 3 to 5 days of development, is transferred back to the uterus(womb).
ICSI(Intracytoplasmic Sperm Injection)- a form of IVF procedure which is carried out to overcome the male infertility factor and it involves injecting single healthy sperm into a mature egg in contrast to traditional fertilization method wherein the egg and several sperms are placed together for the sperm to fertilize the egg on its own.
ZIFT (Zygote Intra Fallopian Transfer), nearly obsolete older form of ART, also referred to as Tubal Embryo Transfer in which although fertilization takes place outside the woman's body but the embryo is transferred into the fallopian tubes instead of the uterus, unlike conventional IVF. This can be considered as IVF variant.
GIFT (Gamete Intra fallopian transfer), also an older form of ART, used rarely now a days. Here, fertilization takes place in the woman's body, however, the sperm and ovum are transferred to the fallopian tube for fertilization to take place.
ART may use donor eggs, donor sperms or frozen embryos. Donor eggs are procured from another woman in order to overcome infertility issues of the woman who has no egg of her own to contribute for conception.
ART may involve surrogate or gestational carrier. Contrary to the popular belief, surrogate and gestational carrier are two different entities.
A surrogate is a woman who donates her egg and gets pregnant from the sperm of the male partner of the infertile couple and carry the pregnancy, in other words, she is biologically related to the child she is carrying whereas a gestational carrier is not biologically related to the child she is pregnant with, she becomes pregnant from egg from the female partner and sperm from the male partner of the infertile couple. Egg or the sperm could be from the donor also procured through the process of IVF. Gestational carrier just carries the pregnancy of the fertilized embryo till term, for another infertile couple.
Q10 What are the indications for opting for Gestational carrier?
A10 Gestational carrier may be considered in case all other fertility treatment options have failed to show some success and there are medical reasons that prove Gestational carrier to be the only viable option for the infertile couple.
A woman who has had her uterus removed surgically due to presence of uterine or cervical cancer, uterine fibroids and severe endometriosis or purely a dysfunctional uterus may opt for a gestational carrier. Heart and other medical ailments that makes the woman vulnerable to developing complications during pregnancy to an extent that pregnancy becomes dangerous to the life of mother as well as the child, they may also consider gestational carrier. The only prerequisite is that the female's ovaries should be healthy and functional to render an egg that can be fertilized through the male partner's sperm or donor sperm and she can be a biological mother to that baby carried by a gestational carrier to full term.
Q11 What is IVF?
A11 IVF stands for In Vitro fertilization. Fertilization of egg that takes place outside the woman's body. It is a type of ART(Assisted reproductive technology) that involves retrieval of a healthy egg(female reproductive cell) and a healthy sperm(male reproductive cell) and fusing them together outside the woman's body, in a lab dish, thereafter transferring the fertilized egg back into the womb(uterus).
Q12 What is ICSI?
A12 ICSI stands for Intra Cytoplasmic Sperm Injection. It is a form of IVF(In vitro fertilization) procedure in which a single healthy sperm is selected by an embryologist and directly injected into mature egg for fertilization to take place unlike conventional method wherein many sperms are placed together with the egg in a lab dish and left to fertilize the egg on its own. It is one of the most common in vitro fertilization method which has given high success rates. It is used to treat the male infertility issues.
Q13 What are the indications for ICSI?
A13 Intra Cytoplasmic Sperm Injection, ICSI is recommended for the infertile couple with severe issues with male fertility involving sperms (quantity and quality)and their fertilizing capacity, such as
Very low sperm count(Oligozoospermia)
Poor quality of the sperms(shape and motility)-Weak motility of sperms(Asthenozoospermia), Abnormal sperms (Teratozoospermia)
Anti sperm antibodies
Obstruction in Vas deferens
Failed attempt at vasectomy reversal
Unsuccessful fertilization(no or poor) with conventional IVF
Using surgical technique to procure sperms from the testicles or the epididymis( a narrow thin tube where sperms are stored and matured and it is located in the scrotum). Surgical retrieval of sperms is done when sperms are not present in the ejaculate (vasectomy) or you have extremely low sperm production.
In case of frozen sperm being used which is not of suitable quality.
Q14 How is ICSI done?
A14 Before you begin your treatment with your consent, which involves doing some paper work, several tests would be done in order to screen you and your partner, if need be, for presence of HIV, Hepatitis B and Hepatitis C, HTLV I and II(Human T cell Lymphotropic virus).
Treatment consists of the following stages:
In case of woman
You will be given fertility drugs in order to stimulate your ovaries so that more eggs are produced. Progress is monitored through repeated vaginal ultrasound and certain blood tests. Subsequently, your eggs are collected and each egg is injected by the sperm from your partner or possible donor. Your specialist may recommend SET(Single embryo transfer), if deemed suitable as you are more likely to have twins or triplets if more than one embryo is transferred.
In case of man
Your specialist will determine if you are able to provide a sperm without any surgical intervention.
Sperm is procured from fresh sample collected on the same day of egg collection from your partner.
Sperms retrieval techniques can be adopted such as
Single sperm is subsequently injected into each egg. Sperm is selected after thorough examination done under specialized microscope by the embryologist. Sperm is suctioned into the injection followed by penetration of the egg by the injection and release of sperm into the egg. The whole process is done under the special microscope. The injected egg is checked for the hints of fertilization after around 16 hrs and if fertilized, it is placed in culture. i.e., after fertilization, if it happens, the resulting embryo/s are allowed to develop for another 5 to 6 days under favorable environment and the best (one to three) out of them are transferred to the womb.
In case of no sperms available either due to vasectomy or otherwise, you can still take a chance with surgical retrieval of sperms through one of the above mentioned techniques PESA, TESA or TESE, although results are not so promising. If the techniques prove futile in procuring sperm, you may wish to consider donor insemination or IVF using donor sperm.
High and consistent success rate
World class, state of the art IVF centres in India, well equipped with the latest technology
No waiting period
High quality treatment at the most affordable cost
Globally trained and highly experienced IVF specialists
Compassionate staff to look after
Accredited with international organizations such as JCI(Joint commission International) for quality standards.
Language no barrier. English speaking people and if required, translators are available for your convenience
Most economical accommodation available at a walking distance from the hospital. Wide range of options starting from guest house, service apartments to five star hotels, best suited to your budget and choice.
Good flight connectivity
India has a diverse and rich cultural heritage. You can witness its beauty and uniqueness. It offers most conducive environment for recuperation.
Dr. Hrishikesh D. Pai
MD, FCPS, FICOG, M.Sc (USA)
Director, Bloom IVF group
President of ISAR(Indian Society for Assisted Reproduction)
Secretary General of FOGSI(Federation of Obstetric and Gynecological Societies of India)
Dr. Nandita Palshetkar
MD, FCPS, FICOG
Director, Bloom IVF group
Hon. Secretary of ISAR (Indian Society for Assisted Reproduction)
Vice President of MOGS (Mumbai Obstetrics and Gynecological Society)
Saket, New Delhi
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