What Causes Unexplained Infertility in Men?

About 30 per cent of couples are diagnosed with unexplained infertility without plausible answers. However, few defined reasons behind infertility apart from low sperm count, poor sperm motility in the man to blocked fallopian tubes or endometriosis in the woman include – DNA Damage in individual sperm.

Millions of couples seeking fertility treatment hop towards India with a hope of low-cost and transparent treatment. When they come to know about “unexplained infertility”, it becomes difficult for them to come in terms with the reality. 

At Pahlajani IVF Clinic, we first establish the causes for infertility before appropriate course of assisted conception treatment.

When males are diagnosed with damaged DNA in sperm, the couples starts panicking and invests a lot of time and money in fertility treatments, such as intrauterine insemination (IUI). However, it is suggested that to first find the possible cause for unexplained infertility in men and later find suitable fertility treatments. This can increase their chances of having a baby.

Also, the chances of having a baby in vitro fertilization (IVF) is closely related to the amount of DNA damage a man has in each of his sperm. A little damage is normal in the sperm of men who are fertile. 

But if there is high sperm DNA damage (more than 25% of damage per sperm), then the couples’ chances of getting pregnant are reduced – even with some forms of fertility treatments.

Doctors carry out a unique test for male infertility that measures damaged DNA in individual sperm. This test provides the couple with specific information about the causes and extent of their infertility. It can also predict the success of infertility treatments leading to reduced waiting times and improved chances of success.

Sometimes, the answers provided by fertility doctors are not satisfying, which therefore leaves the couple in dilemma about the whole process. In such a situation, a couple should remember that fertility doctors and reproductive endocrinologists are likely to make mistakes. Not always, but few fertility specialists miss out something that another could catch right away. 

It is better to be informed about the procedure and keep your queries before doctors without reticence. It will be better for both doctor and the couple. If you’re not satisfied with your doctor’s opinion or diagnosis of unexplained infertility, you need to get a second opinion.

Dr Neeraj Pahlajani

Understanding the Results of Semen Analysis - Sperm Structure and Motility

Male infertility contributes about 33 % in failure of conceiving. If you are trying to have babies but the attempts were left futile, then one of the important tests that men should undergo is Semen Analysis Test. The test would determine the man’s sperm count, motility and production, which are important for pregnancy.

Anatomy of sperm divides it into three sections:  

• Head
• Midpiece
• Tail

For a sperm to be considered normal, all the three above sections should be have specific structure for motility. A little description would help you understand about these three sections and what actually is determined in sperm test.

What is a Sperm Made of?

Under the microscope, the trisection of sperm is observed more closely,

Head, having larger surface area than the other two sections stores all the genetic material. Now, if the sperm has an abnormal head, it is incapable of fertilizing an egg.

Midpiece, an area between head and tail of a sperm contains fructose, which gives the sperm required energy to gain speed and move faster.

Finally, the tail for forward motion and it gives thrust to the sperm. So, a sperm with no tail, two tails, or coiled tails are abnormal, and won’t help with getting pregnant.

What Does Your Semen Analysis Mean?

Once you are handed over the report of your sperm test, you see the terminologies, sperm volume, concentration, motility, or morphology. Don’t get confused! These terminologies would be reliable source of information if you know,

1. Normal sperm volume (amount) – Between 1.5 and 5 ml.
2. Normal sperm concentration – greater than 20 million sperm/ml or a total of greater than 40 million per ejaculate.
3. Normal sperm motility - more than 40% of the sperm should be moving.
4. Normal sperm morphology - more than about 30% of sperm should be normally shaped.
5. Normal sperm forward progression - at least 2, on a scale of 1 to 4.
6. Sperm white blood cells - no more than 0 to 5 per high-power field.
7. Sperm hyperviscosity - the semen should gel promptly, but should liquefy within 30 minutes after the sample is taken.
8. Sperm pH - alkaline, to protect sperm from the acidic environment of the woman’s vagina.

Special instructions to collect sperm for a semen analysis

Before undergoing the test, men should,

• Abstain from sexual intercourse for 2-3 days before providing semen for analysis;
• Generally, the sample is frequently collected by masturbation. But, sometimes the technicians might also collect it after sexual intercourse, using a special condom that lacks spermicidal agents that are detrimental to sperm.
• The sample may be collected at home or in an appropriate laboratory.
• Men undergoing the test should ensure that the sample is kept at room or body temperature and is tested within an hour of collection.

Remember, your sperm test results may vary with unusual sperm count, motility, or production, if you were not well, going through routine medications or ill, taking medication.

Dr Neeraj Pahlajani

The Best Time for Getting Pregnant - 3 Signs of Fertility

Pregnancy is never sudden rather it depends on the pattern of ovulation. Predicting ovulation would help you identify the best time of the month to conceive a baby. Before going for those predictor kits, here are few things that you must know about ovulation.

Women’s menstrual cycle is divided into three phases:

• Pre-ovulatory infertile phase
• Fertile phase, and
• Post-ovulatory infertile phase

By observing the primary fertility signs, women can determine which of the three phases they are in. The three primary fertility signs are:

Waking temperature

If your waking body temperature rises between 97.6 to 98.6 degrees Fahrenheit, you are surely ovulating. And if it between 97.0 and 97.5 Fahrenheit, you are not ovulating.

Understanding the highs and lows of your body temperature would help you to know if ovulation has occurred. The considerable rise in waking temperature indicates the occurrence of ovulation. However, unlike the other two signs (cervical fluid and cervical position), waking body temperature does not reveal impending ovulation.

Cervical fluid  

This is the sign of impending ovulation. Body produces cervical fluid before you ovulate. Fluid acts as filtering mechanism to nourish the sperm. It creates an alkaline environment and encourages the sperm to reach the egg.

With the approach of ovulation, the in female body estrogen rises and the cervical fluid becomes more evident. It is first a little sticky, and then a creamy discharge. The final phase of cervical fluid is a clear, slippery, stretchy substance (similar to raw egg white). This is a sign of fertility — and recognizing these signs quickly can help you conceive.

Cervical position

Women find it difficult to spot this sign of ovulation, as it is hardest to predict and needs practice finding the cervical positions that indicate optimal fertility. Every month, women’s cervix prepares for pregnancy by becoming soft and “mushy”, rising a little higher, and opening up. The increase in estrogen secretion causes the cervix to change angle as well, and to emit fertile cervical fluid.

Women need to start observing the minor changes in their bodies to predict cervical position. Slowly, in each cycle you will be able to determine when your body is fertile and ready for pregnancy.

Watching the natural symptoms of ovulations during the phases of your menstrual cycle, would help you knowing the most fertile time to get pregnant. It is not that you cannot get pregnant during other times, but the knowledge of above three signs would increase your chances getting pregnant when you really want to. Do not forget that eating habits affects female fertility. So, eat healthy and add more nutrients to your diet.

Dr Neeraj Pahlajani

Reasons In Vitro Fertilization (IVF) Fails to Result in Pregnancy

The bitter truth behind a botched IVF cycle is – as advanced as fertility treatments are, the question about failure might not always have an answer!

When the embryos looked perfect, uterine lining looked great, and everything went according to prescription, then it is difficult accept the failure of IVF cycle.

Below are the reasons why sometimes In Vitro Fertilization doesn't work –

The embryos didn't implant

When the development of embryos stops prior to reaching implantation stage then uterine lining may possibly reject the embryo and the implantation fails. Women, in their mid 30s, who undergo IVF after detection of infertility, are more likely to encounter this situation. However, the cessation of embryo development is thought to be the most common cause of lack of pregnancy at any age, and in fact, even during natural conception. A woman’s age affects her chances of getting pregnant, whether or not infertility treatments are involved.

The embryos started to implant…and then stopped

If the embryos have abnormal chromosomes, they won’t implant. The only way to tell whether embryos have the right chromosomes is to do Pre-implantation Genetic Diagnosis (PGD), a procedure in which one cell is removed from the embryo before implantation and its DNA is analyzed for abnormalities.

Although this is an expensive medical procedure, it only checks the abnormalities and does improve overall pregnancy rates.

The embryos were damaged, so the IVF didn't work

The damage, either during the embryos’ growth in the lab or the transfer to the uterus might result in implantation failure. Like I have always said, the IVF is performed part by doctors and part by human body. From simulation to egg formation, retrieval to embryo formation, embryo transfer to implantation, IVF is requires both the efforts of doctor and response of the female’s body to the effort. Occasionally, the embryo does not grow as intended, which might damage the embryo.  

There is a problem with your uterus

If the uterine lining is not healthy or ready for the implantation, then there are chances your IVF would not work. Fibroids, polyps, or polycystic ovarian syndrome can make getting pregnant more difficult. Sadly, there are no ways to test the endometrium or uterine lining during the actual cycle because a biopsy might prevent implantation.

The embryo transfer process went poorly

If a woman experiences bleeding or cramping (or both) during the in vitro fertilization procedure, the chances of getting pregnant are considerably decreased. The uterus cramps, the embryos are displaced and become less capable to be implanted, as a result the IVF cycle fails.

Sometimes, patients blame the doctors. It is understandable because one might not want to expense of money and time without results. But, even though the infertility treatment is one of the most advanced medical procedures but sadly there are arenas which are yet to be discovered, like the prevention of implantation failure. You need to be positive and have faith on your doctor.

Dr Neeraj Pahlajani

When You Need to Find a Fertility Doctor

To know when exactly you need to go to a fertility doctor when you haven’t been getting pregnant could be difficult, partly because it is expensive and more importantly it feels like it means you have lost hope for a natural pregnancy and more.

The problem becomes more complex when you decide on visiting a gynecologist, who unfortunately does not specialize in infertility or works closely with an urologist, the you might be subjected to a series of futile tests that may deplete you finances before you even think about visiting a fertility specialist (who again might prescribe a number of tests) as your next preference.

How to Know You Need to Find a Fertility Doctor

If you are trying hard but it taking too long to get pregnant – whether it is six months or even two years – you need to actually start thinking about reasons.

Sometimes, women fail to reckon that male infertility might be the contributing factor. Male infertility equally contributes to problems getting pregnant just as often as female infertility does.

So, if you encounter problems in getting pregnant, then it is time you visit a fertility specialist, who would guide you through the right path to get out of the maze.

Signs it’s time to see a fertility specialist for both men and women

1. You've been trying to get pregnant for over a year without success – This is the commonest and most obvious sign you need to find a fertility specialist. When you are under 35 years of age and have been trying to conceive for 12 months. Or, you’re over age 35 and you’ve been trying to conceive for more than 6 months. This is because, a woman’s chances of getting pregnant decrease as she ages — no matter how healthy, fit, and active she is! And, male sperm health decreases as he ages, too.
2. You or your partner has chronic or past health problems – Diabetes, high blood pressure, or a history of cancer, are few examples that might affect the functionality of you ovary or testicles, putting your ovarian response or sperm production to back seat. 
3. You've been seeing a family doctor for six months – If the pregnancy seems far-fledged after months of struggle even when you are consulting a family doctor for the same, then you need to see a fertility specialist, because sometimes family doctors are not the best infertility evaluators. Do not feel like you are betraying your family doctor! You can ask him for referral to a fertility doctor instead.
4. You have irregular periods - If you have pelvic pain, heavy periods, and/or bowel or bladder symptoms around your menstrual cycle and the physician does not suggest having a hysterosalpingogram or laparoscopy to determine the cause, then you should see an infertility doctor.

Going to a fertility clinic may help you feel more in control of your journey towards getting pregnant – especially if you know what to look for when finding a fertility doctor.

Dr Neeraj Pahlajani

Signs of Fertility Problems in Women

Women in their busy routines, sometimes ignore the small problems faced repeatedly during the menstrual cycle. However, at some point of time they actually start thinking if they will be able to conceive a baby. But how do you know if you have fertility issues? 

Here are few common signs of infertility to raise an alarm before it is too late,   

The first and most obvious sign of a fertility problem is the lack of ability to get pregnant. Unless you want to actually get pregnant, you would not be able to encounter the problem. Birth control pills or condoms might keep you away from knowing these problems. 

So, all you need to do is try getting pregnant for few months. If you fail in the process try consulting a fertility specialist. 

Signs of Possible Fertility Problems for Women

Irregular periods (or no periods at all)

If you do not get your periods between regular intervals - or if you don’t get periods at all – then you may have fertility issues.

Sometimes, because of hormonal imbalance women get irregular periods and develop polycystic ovaries. It is not uncommon, about 10% of women are affected by this common health condition, which causes very small (less than 1 cm) cysts on the ovaries. Now, development of cyst might affect your fertility.

Pain during period

Fibroids, yeast or other infections, pelvic inflammatory diseases, and endometriosis can cause pain during menstruation. Is this a sign of fertility problems? Again, it depends on the reason for the pain. Some women have fibroids that don’t cause painful menstrual cramps. However, sometimes it becomes important to get them removed before in vitro fertilization.

If you experience painful cramps or abdominal pain during your period, go see a gynecologist. A minor fertility issue can grow into a serious problem if it’s not taken care of.

Painful sex

Although, not every time painful sex might lead to fertility problems but it depends on the reason of pain. One of the major reasons could be, Endometriosis - it can be problematic if you want to get pregnant. To know more about Endometriosis visit – www.raipurivf.com

The first thing you can do when you have acute pain during intercourse is to consult your family doctor or gynecologist. Determining the actual cause of pain would allow you to discover if there is a threat to your fertility or not, because not always painful sex means infertility.

Sexually transmitted diseases

If you have STDs or sexually transmitted diseases, you might experience pelvic inflammatory disease, which is an infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. 

The most of symptoms of Pelvic Inflammatory Disease (PID) is lower abdominal pain.

STDs such as gonorrhea or chlamydia can cause fertility problems in women and men. 

In women, the problem comes from scar tissue buildup that affects your ability to get pregnant.

Common Reasons Women Can’t Get Pregnant

• Age – women lose fertility after age 30, more after 35, and faces acute problems in conceiving after age 40.
• Underweight or overweight – women with Body Mass Indexes (BMIs) over 30 and under 20 have better chances of getting pregnant. Ideal BMI is between 20 and 30.
• Hormonal changes – can cause fertility problems.
• Endometriosis or fibroids – can make getting pregnant difficult, depending on how advanced the disease is.
• Miscarriages – the more miscarriages a woman has, the less likely she may be to get pregnant.
• Sexually transmitted diseases – can affect a woman’s reproductive system.
• Pelvic inflammatory disease – can cause problems with getting pregnant.

Dr Neeraj Pahlajani

Natural Cycle IVF - Procedure, Treatment and Benefits

Natural IVF cycle or gentle IVF is a simpler way of doing in vitro fertilization. It is beneficial for patients with poor ovarian reserve because they do not respond well to superovulation with gonadotropin injections. The process is done using minimal or sometimes no ovarian stimulation.

It is a preferred because of the following perspectives,

• Fewer side effects
• Less expensive
• Good success rate
• It can be repeated

However, the patients treated under this type of IVF should understand the challenges involved in the treatment. The procedure is quite demanding in terms of egg retrieval timing and fertilization of egg.

The process adapted at Pahlajani Infertility Clinic for natural IVF involves,

1. We start with vaginal ultrasound scan on day 7 to estimate the follicular size and thickness of the endometrium and ensure the viable and growing follicle.
2. After the confirmation, the patient is given Gonadotropin-releasing hormone (GnRH) (also known as Luteinizing-hormone-releasing hormone (LHRH)) antagonist medication to avoid untimely LH surge.
3. Later, the scan and E2 blood test is performed on Day 10.
4. We wait for the follicle size to grow about 18 mm and E2 (estradiol) level to reach 200pg/ml, and then give the HCG trigger shot.  In general, a 'good' estradiol level is between 150- 500 pg/ml on day eight of an IVF cycle. Approximate doubling of the day eight value every 48 hours is a positive sign of continued follicle development. 
5. After 36 hours of the HCG shot, we collect the egg. 
6. Embryologist fertilizes the egg and the formed embryo is transferred to the patient’s uterus within 48 hours.

Another treatment that we recommend at Pahlajani IVF Clinic is mini-IVF. It has better pregnancy rate and involves mild super ovulation to ensure the growth of 2-3 follicles. The treatment is similar for mini IVF as used in natural IVF with some additional medical treatment. 

In mini-IVF, the first scan is performed on Day 2 to absence of ovarian cysts and down regulation. The slight difference is that the patients are put through Letrozole from day 2 to day 6 and Menogon from day 3 onwards. The scan is performed on day 7 and rest of the procedure is similar as natural cycle.

Dr Neeraj Pahlajani

 

Why do some doctors prescribe so many tests after a failed IVF cycle?

Before undergoing IVF, the infertile couples are explained about the prospects of the treatment, with a clear picture about the chances of success and failure. However, after undergoing the process, patients sometimes become more emotional than rational. 

Now, when a doctor informs that the cure of infertility might be IVF then failure of the IVF cycle puts a pressure on the doctor to give the elaborate explanation for the same. To avert the blame game, few doctors prescribe a panel of expensive tests following an IVF cycle failure. Reason, obvious to find out the cause of failure.

Actually, the reasons of failure can be multiple and it is not possible for doctors to find the exact one. Sometimes, under the pressure mounted by patients few doctors run a list of tests to uncover the reasons. Wanting to be provided with best and logical answers, patients are in continuous efforts to question the doctor. 

It is obvious because undergoing IVF through emotional and financial pressure is something not everyone can afford. Understanding from the doctor’s point of view, IVF is performing a natural process outside the body. What is performed in the laboratory (formation of embryo) is within the control of doctors but after implantation not even doctors can have control over a natural process. It depends on how our body reacts to a particular external procedure.

Running a panel of tests might sound logical but actually would be a complete futile effort to justify the IVF cycle failure. Again the reason is these tests provide very less useful information. There is no particular test to check why the cycle failed. There are few related tests that might be like running round the bush but not giving the exact information. Reacting to the pressure mounted by patients, doctors perform these tests to satisfy their patients.

If a doctor tells them that he does not know why the cycle actually failed then it might endanger the reputation of the doctor. So, the best way to control the damage is leave the answers to the tests. Test results (cryptic in medical terminologies) might serve the answers to the queries of patients.

Doctors would want every IVF cycle to succeed and if it would have been possible to predict the reason behind the failure then the subsequent patients undergoing IVF would never have to face the failure. If these tests would have provided the information then doctors would have performed it before the IVF. Generally, the doctor would recommend immunological tests, tests for endometrial function, and sperm DNA fragmentation tests but these tests are expensive and not useful.

Now, the patient would want to know that if these tests are futile then what is the solution? The only solution is proper counseling of patients and having realistic expectations. So, when the first cycle fails, the patients would be able to translate the reasons for failure without unnecessary tests. A well-informed patient would then realize that embryo implantation is a biological process over which we have very little control and so it is impossible to control the embryos once it is transferred. 

At Pahlajani IVF Clinic, the patients are counseled about the foreground and background of the IVF to give a crystal clear image about the actual process to patients.

Dr Neeraj Pahlajani

What husbands can do for wives going through IVF?

Women going through IVF are emotional susceptible. The phase is both beautiful and emotionally challenging for her. She is going through a change of creating a being. It takes a toll of her emotions, and might even take away her self-esteem if ignored. So, her craving for attention and care is understandable. From husbands, essentially, the extra care and support is expected. 

As, even if the embryo is turning into fetus inside a woman but the fetus should grow under the nurture of both father and mother. Husbands should know that their wives had to fight through infertility (maybe after few IVF failures) to conceive. Most of the time women find it is difficult to have a discussion about infertility with friends and family, at that moment husbands are the lone support system.

Husbands need to find ways to fill the isolation of women with love, happiness and support. Accompanying your wife to understand the realistic perspective of IVF, related treatments and assuring her that you are always there for her even during the worse would give her strength to fight the problems.  

This article has been written in a thoughtful of how husbands can contribute equally in IVF success. Sometimes, women feel that they have to fight the battle against the sea of problems alone. Women are silenced by the reluctance of shame attached to infertility. This might transform them from social animals to closet thinkers.

Husbands are known as the better halves only because of the reason that half of everything happening in women’s lives is experienced by them. It is advisable that husbands should give a patient ear to women and melt the ice of inhibitions.

The most important promise you can make to your wife is by telling her that no matter whatever be the circumstances you will be there with her and infertility is not her fault. Everything will be fine and you both will together work it out. You love her as a woman and as a beautiful wife. She allowed you to step into her life. It will give the best comfort.

Husbands can rummage through the internet or read books to know what she is going through and what all can help her lessen the stress. Reading would give you an in depth knowledge and give you best understanding. Internet can sometimes be the best guide to discover best options to fight infertility. Wives would definitely appreciate your effort and the research would help both of find best the way. 

If you and your wife are going through an IVF cycle, husbands can play their part by reminding their wives to take medications on time, make sure that she eats healthy, she is not stressed out and she does not feel alone. The time will elapse more easily if two of you go through it together. All the best! 

Dr Neeraj Pahlajani

Reasons Why Infertile Couples Do Not Opt for IVF Treatment

In Vitro Fertilization (IVF) or test tube baby technique was introduced in 1981 and till date millions of babies have been born using this treatment. Overwhelming figures speak volumes about IVF success rate. IVF might sound a cryptic medical terminology but is one of the lone treatments for infertile couples to have their own genetic babies through Assisted Reproductive Treatment. It has served as a boon for many infertile couples wanting to become parents.

However, many couples are resistant to undergo the treatment despite the high success rate. It was observed that while few couples unfortunately cannot afford the treatment, many are bound by orthodox beliefs.  

Infertile couples tussle to undergo go the test, based on the doubt factors-

• Chances of success
• Cost
• Men are sometimes insecure and think that undergoing IVF might question their manhood.
• Women consider themselves guilty partner for infertility.
• Many consider IVF an artificial procedure.
• Few feel that babies born through IVF are at increased risk of birth defects.

These reasons not only shield the couples from technology but also reduce their prospects of having a baby. The factors that increase the chances of success depend on how much the couple and the doctor are dedicated to make the process success. 

However, when the finances are concerned, IVF is indeed a treatment that might burn holes in the pockets. Sadly, the insurance companies do not consider infertility under a type of disease and do not cover this procedure.

Financial considerations are further strengthened by misconceptions and horror tales to resist the couples to opt for procedure. Also, men should understand that infertility is not uncommon, and men are not individually responsible for infertility nor women are but the contributing factors lead to infertility. So, resorting to IVF would not be an affront to their manhood.

Meanwhile, few couples who start believing IVF as an artificial procedure should understand that IVF is performing the natural process outside the body. In IVF, only forms embryos outside body and are later implanted in the uterus for natural pregnancy.

Knowing that IVF requires stimulation of ovaries, retrieving eggs from follicles which otherwise would have been discarded and performing the process in labs increases the doubts of couples, who start thinking that manipulating the natural process using hormonal injections might adversely affect the baby and become a cause of birth defects. They hear the stories from couples who have had failed IVF cycles and start considering IVF as a bane!

It is unfortunate that people with half-baked knowledge try to misguide the infertile couple who are already susceptible. Sometimes, even gynecologists refrain from suggesting the proper treatment and advise them against IVF specialists. These factors contribute to the reasons why patients are reluctant to undergo IVF.

Knowledge is power. Rather being susceptible to false claims and rumors, patients should grab the knowledge by consulting an IVF specialist. We at Pahlajani IVF Clinic counsel the patients before suggesting any kind of treatment. 

It builds a bridge of confidence between doctor and patient. Patients should read such informative blogs on internet and stay away from hurdles that give them only doubts not hopes to get have babies.

Dr Neeraj Pahlajani

Blood AMH – a test that every young woman should undergo

Many physicians warn that though you may be enjoying good health, feeling healthy and being healthy are not always the same thing. Like most of the adults, you may be undergoing a regular annual medical examination to assure good health. One of the most common tests performed under the routine is Cholesterol, to calculate the risk of heart disease.

However, this test might be beneficial for men and women above 40 but for a woman in her late 20s, it is a futile to undergo this test. Generally, the chances of women at this age to be diagnosed with a heart disease are slim. 

So, instead of undergoing worthless tests, it is better to prioritize your test chart according to the need. Customizing the tests according to the age would help you find out the exact problem, rather than tests which are generally not recommended at your age.  

So, it is more valuable for women to undergo blood AMH level (a test to determine ovarian reserve) to check the quality and quantity of eggs she is left with. This is because, ovarian reserve declines with age and it is irreversible to achieve back the eggs that a woman has already lost during menstrual cycle. This is test is valuable for women who want to postpone child birth due to career or some other constraints. The AMH level testing provides a good index of ovarian function.

There is multiplicity of reasons why new age women tend to postpone childbearing. It might be because of career or the quest to find the right partner. While this can be a good sign towards social evolution, where women are taking independent decisions, it might be a biological hitch for some. 

Sometimes, in the race of life, women tend to forget that they might have extended the age of getting married but their ovary never stops to grow old. It constantly loses eggs and the quality and quantity declines tremendously with age. When a women strides towards her mid-30s and she might be satisfied to have a settled life, she already has reduced chances of pregnancy.  Much to her dismay, she might fail to achieve pregnancy without medical assistance.

Sometimes, women are baffled to hear this news! They are shocked to know about their ovarian functioning despite having regular cycles. They regret to have had known about such a situation much earlier to have avoided complexities at the young age.

So, if you are in your late 20s and have decided not to start family any time soon then it is recommended for you to undergo blood AMH level testing annually. It is an inexpensive test and demands no extra testing but blood test. This test would provide you a rough idea about ovarian reserve, specifically the quality and quantity of eggs you are left with. Therefore, how much time you have to actually start planning your family.

This test is recommended because a number of women experience infertility and sometimes it is too late to know about it. However, it is important to know that for a woman with unproven infertility with a low AMH level might conceive and have baby without any complications, while AMH level testing in an infertile woman is completely different. 

The test is useful to know about the declining ovarian reserve, so that your doctor can warn you before it is too late. If a woman knows about her eggs beforehand, then it would be much easier for her to determine the right age to plan her family. With the data about AMH level, it will be easy for even your doctor to counsel you about making the right choice.

With AMH levels, women in their late 20s, who have enough time to have babies, can make well-informed decision. If a woman is young and has low AMH level, then she can decide whether she has to have baby or may freeze her eggs when their quality is good, so that the frozen eggs can be used when she wants to get pregnant few years later.

It is recommended for young women to undergo blood AMH level test annually to avoid facing unforeseen results in future. All the best!

Dr Neeraj Pahlajani

Dr. Pahlajani Test Tube Baby Center Raipur: Does IVF cause premature menopause?

Dr. Pahlajani Test Tube Baby Center Raipur: Does IVF cause premature menopause?: Women are born with a certain number of eggs and IVF  stimulation of ovaries to produce extra eggs in single menstrual cycle might logic...

Does IVF cause premature menopause?

Women are born with a certain number of eggs and IVF  stimulation of ovaries to produce extra eggs in single menstrual cycle might logically let your ovarian reserve exhaust and push you enter early menopause!

Normally, women with menstrual cycle length between 28 to 30 days ovulate 12 times/year producing one egg for every cycle. So, she uses only 12 eggs per year. However, one IVF cycle demands the harvest at least 15 eggs or more for one IVF cycle through stimulation of ovaries with hormones, so as to make use of best few eggs. 

Now, multiple IVF cycles (in case of recurring failure) might make use of dozens of eggs. Mathematically, the ovarian reserve of women undergoing the above process should deplete than normal and she should find herself standing on the last leap of her menstrual cycle, staking her long-term fertility.

However, the laws of medical logic annul all such absurd facts. Scientifically, ovaries are the pair of egg reservoirs situated in pelvic region of women. Eggs are the cells which are also called genetic blue prints that create babies with male sperm. Ovaries have specialized structures called follicles to store, protect, and nourish eggs.

Between 18-22 weeks of gestation, a female fetus contains about 2,000,000+ follicles in its ovaries and each follicle contains one egg. However, the fetus loses 80 % of its eggs at the time of birth and it is left with only approx 3,00,000 eggs in her ovaries. From puberty to menopause, she loses almost all her follicles. During her lifetime menstrual cycle, a woman normally ovulate around 400 eggs, releasing one mature egg each month.

Most of the immature follicles inside ovary do not mature to release eggs. So, around 99.99 % follicles do not serve any biological purpose by not releasing eggs.

How ovary functions during menstrual cycle?

With the start of menstrual cycle, the pituitary gland secretes Follicle Stimulating Hormone (FSH) to stimulate the ovarian follicles. In response the follicles start growing and out number of follicles one follicle (called dominant follicle) carries the mature egg. This mature egg is released during ovulation. Meanwhile, the other follicles which fail to mature are lost in the process. These follicles die in a natural process called atresia.

How ovary functions during IVF?

During IVF, women are injected with high amount of FSH, higher than the body normally produces. High FSH matures higher number of follicles to produce potential eggs in single cycle. This is done to retrieve maximum number of eggs in one cycle for embryo formation. 

This is the reason why IVF treatment will not deplete your ovarian reserve because, the stimulation matures the follicles which would otherwise die. This is why the IVF treatment does not cause premature menopause. Even if you have multiple IVF cycles, it would not affect your ovarian reserve.

However, the other parallel truth is infertile women have higher risk of early menopause because of already poor ovarian reserve. It is due to the biological functioning of their bodies and it has nothing to do with IVF or number of IVF they are subjected to. So, if you are infertile and you enter menopause after IVF then please understand that it was not IVF which exhausted your ovarian reserve. You would have entered early menopause anyway, even without undergoing IVF.

Dr Neeraj Pahlajani

Embryo Transfer - Do’s and Don’ts during 2ww

Generally, patients find themselves wedged in a situation, where it is difficult to decide what is good or bad for them. Sometimes, they restrict themselves to function normally and allow unnecessary stress to permeate their lives. Below is a list of do’s and don’ts that would help you through 2ww,

Do’s

• Eat healthy
• Avoid complete bed rest
• Follow medications routinely
• Follow simple yoga regime
• Do things to keep yourself happy and relaxed
• Avoid self-blame if the IVF cycle does not succeed
• Read good books.
• Be a part of surrounding that makes you happy.

Don’ts

• Do not doubt yourself.
• So not use sauna, hot tubs, or any activity that might increase your body temperature.
• Do not exhaust yourself mentally or physically.
• Stay away from negative surrounding
• Avoid watching or reading stressful things.
• Do not change your diet completely. If you want to switch to healthy eating habit, do it slowly. 

Dr Neeraj Pahlajani

Embryo Transfer FAQs

How long is the process of embryo transfer?
Few minutes, before you are done with embryo transfer in your uterus.

Can I take a long journey back to home immediately after embryo transfer?

Yes, air travel or any mode of transport has no affect on embryo. It will do no harm to the pregnancy. The precautions are to keep yourself hydrated, move frequently and not sit for long.

Is bleeding normal after embryo transfer?
Bleeding after transfer is not usual. Most of the time, the embryo transfer does create trauma to your cervix or endometrium, so the patients should not experience bleeding or spotting after an embryo transfer.

However, some patients with narrow cervical opening (called cervical stenosis) may experience bleeding after the transfer. But there is no reason to panic because the blood is not from uterus. Your embryos are completely safe. We, at Pahlajani IVF clinic show our patients the embryos before they are transferred to your uterus.

What does embryos look like before and after transfer? 

Embryos are the minute microscopic cells which one could not see through naked eyes. You need a microscope to view them. Since, the embryos are living cells, so they constantly divide and look different with each passing day after fertilization. Doctors identify and compare the size of embryos with each day. 

Is wet discharge normal after the embryo transfer?Wet discharge is not from inside your body rather it is the sterile fluid used by doctors to cleans your vaginal canal and the cervix. So, it is normal that you experience a little wet discharge after embryo transfer but do not worry your embryo is safe inside your uterus and the wet discharge did not wash it out.

Do I need to adhere with some eating rules before embryo transfer?

No, you can have normal food as embryo transfer is not done using general anesthesia. So, the patients are not given any diet chart before the transfer. They simply need to follow normal guidelines provided by the clinic.  

Dr Neeraj Pahlajani

What you need to do immediately after Embryo Transfer?

Do you fear walking around, or standing up after embryo transfer through IVF? Women tend to worry about purge out of their embryos through the channel of implantation. After all, if the embryos are transferred through the uterus through the cervix, then it is reasonable for a woman to think that the embryo might slip out through the same route. 

Understandably, women are protective about the to be fetus and tend to feel, if they sit stiff in one position the embryo might stick to the wall of uterus and if they walk or do some physical activity, the embryo might get disturbed. 

Few women fear to go to the toilet, they think if they pee the embryo might get removed.  However, if women understand the construction and properties of the uterus, it would be easier for them to feel normal after embryo transfer.

ANATOMY OF UTERUS

Uterus is a muscular of organ about the size of a fist. The walls of the uterus are in close contact with each other with no gap of hollow space. So, when an embryo is implanted, it is protected between the walls like a seed when sowed is buried inside the soil. It is an interlocking, where the walls hold the embryo between the contractions like when we hold a small seed inside our pressed palms. 

The palms create a suction area around the seed and hold it even if we move or jerk our hands. The seed will not get dislodged in any direction you move your hands. Similar is the function of uterus, it holds the embryo between the walls. The embryo, when implanted is small and microscopic and through the weeks it makes its own space by adjusting inside the walls.

Also, the 'uterine cavity' is a medical reference; it does not mean that the uterus is a cave like structure with a void inside. There is no real ‘space’ between the walls. So, nothing can disturb the embryo inside the uterus once implanted, neither jumping nor going to pee. Any kind of external physical activity cannot disturb the embryo. 

So, it is SAFE to walk, pee or even dance. Human body has its own structural complexities to handle the inside environment, so without worries allow the organs to work according to their intelligence.

Even the belief about weeks of bed rest after embryo transfer is completely wrong. Bed rest has not been scientifically proven to improve pregnancy rate in embryo transfer. Bed rest would in turn harm you physically and emotionally. No work or physical activity would give you additional complications like back ache, decrease uterine blood flow by reducing pelvic circulations, laziness or gastric issues. 

When you rest and do absolutely nothing, then you may start thinking about negative aspects, become pessimistic and the whole IVF cycle might turn out a stressful process because a body rests but the mind starts working in double pace. Women should be energetic, follow their normal routine, eat healthy, little workout or brisk walk would make a perfect healthy environment for a fetus to develop.

Do not be scared to sneeze or cough, do not hold the pee in fear. Even if you have orgasm while sleeping (it usually happens during 2ww), don’t worry, your embryo will not be dislodged in any case even if you have intercourse. Feel normal and stay calm, allow the organs to perform their functions. 

Wash the old myths out of mind that bed rest and house arrest would keep your baby healthy. Your fetus needs fresh air, healthy environment inside. So, if you rest for the whole time and do not allow your body to function, then how will your fetus get a healthy environment?

A couple, and most importantly the family members should understand that bed rest would not improve the pregnancy. All the best! 

Dr Neeraj Pahlajani