Who does not wish to conceive naturally? It is everyone’s desire! Even with everything normal, the chance of a natural conception in each natural cycle is just 20%. The cumulative rate is about 80 % after a year of regular intercourse. But in some instances, it may not be possible for a couple to conceive naturally. This is where we come to your help. Infertility could be due to various causes. Broadly the cause can be female factor involvement – ovarian, uterine, tubal or male factor or unexplained infertility where all female and male-factors are ruled out and everything seems normal.
Infertility is traditionally defined as a couple that is unable to conceive after 1 year of regular intercourse. In older women, it is unwise to wait as long as a year hence the time is reduced to 6 months. But here we will be talking about those instances when the cause of infertility is known and there is no point in waiting for a natural conception just to term the couple infertile. Let us see what these could be and when a couple should not wait to seek In Vitro Fertilization (IVF) treatment.
When bilateral tubes are blocked and a corrective surgery to repair the tubes is not possible, natural conception is close to impossible to occur. Here the only alternative is in vitro fertilization and implantation of the embryo inside the uterus.
Severe male factor infertility. An Intrauterine insemination (IUI) can be performed when there are total 10 Million actively motile sperms in the semen sample. Severe oligospermia counts less than 4 million/ml require ICSI. Total motile sperm count less than 10 Million will not benefit from IUI, they would need IVF.
In an elderly couple, a delay in management could be disastrous. After all, a woman comes with a limited reserve of eggs, and a delay would mean a further reduction of her ovarian reserve to a point where it may not be possible to get any eggs of her own, even with high doses of controlled ovarian hyperstimulation.
After 3 failed IUI’s it is unwise to wait. An IUI increases chances of a pregnancy 10% over the natural conception rate of 20% in each cycle. IVF-ICSI which is intracytoplasmic sperm injection has better results in the range of 40 to 60% in each cycle depending on various factors, the most important being the number and quality of oocytes retrieved and a normal endometrial cavity.
If a man has a varicocele with reducing counts, he may come with earlier reports of a normal semen analysis and with latest reports of a decreasing sperm count and reduce motility. This may even eventually lead to azoospermia and is wise for the couple to undergo IVF-ICSI before further reductions in count occur. One such couple did come to us at Dr. Sudha Tandon infertility and endoscopy center and underwent IVF. They had to be told not to wait as the male partner had a varicocele with very low counts. He was told by an andrologist that his counts would not increase even after surgery as it was in late stage and increase even after surgery as it was in late stage and the sperm damage was irreversible. They underwent IVF and were blessed with a child in the first cycle. They went home happy with a bundle of joy!
Increasingly we are seeing women with a low ovarian reserve at a younger age. They may not understand the implications of a report of a low antimullerian hormone (AMH) or Antral follicle count (AFC) but it has to be very explicitly explained to them that they are running out of time. Most often they find it difficult to accept but this had been a reality that most younger women are having the premature ovarian failure in today’s time. This is when IVF-ICSI must be offered to them and they must be advised to act soon and not delay their treatment.
Of course, if a couple wishes to undergo Preimplantation Genetic Screening (PGS) to know if the embryo has incurred any aneuploidy or any known genetic defects, it has to be performed only via IVF. Also, when either partner has a transmittable genetic mutation that may variably affect their offspring, it needs to be checked by Preimplantation Genetic Diagnosis (PGD). This also requires IVF. Also for surrogacy, IVF would be essential.
Most couples are aware of their options and are well read. Some find it difficult to accept that they have a problem. Some find accepting IVF difficult. Ultimately it is a choice the couple needs to make
based on their desire for a child. We just help make that process easier and a possibility!
Author: Dr. Aditi Tandon Prabhu
Dr. Aditi Tandon is a gynecologist at Sudha Tandon Fertility, IVF and Endoscopy Center. She has a keen interest in Gynaec Endoscopy and Infertility management. She has completed her under graduation from K.J. Somaiya Medical College and post-graduation M.S. OBGY from Rural Medical College, Loni (2016). She has a keen interest in infertility and has observed and assisted various Assisted Reproductive Technique procedure such as IUI’s, follicular monitoring scans, Semen preparation, Embryo loading, Semen and embryo freezing, ICSI, ovum pick-up and embryo transfers as well as observed stimulation protocols in the OPD.