Infertility is a relatively common condition affecting one in 6 couples. Despite this, it remains a taboo. It affects the couple psychologically, economically and socially. They avoid meeting people as “children” will be a topic of conversation. Everybody you meet wants to suggest options. Seeing an infertility clinic is one of them. With the word “infertility clinic” many couples freak out.
‘Smoking is injurious to health’. This applies to reproductive health as well. Passive smoking is equally harmful, but not many women are aware of this. One survey of female hospital employees found that less than 1 in 4 knew that smoking could hurt their fertility or increase the risk of miscarriage.
Myth 01: Infertility is rare.
Infertility can affect women of any age and from any background. In fact, approximately one out of every seven couples trying to conceive today experience difficulties with infertility. The Centers for Disease Control and Prevention (CDC) reports that 12 percent of women in the U.S. ages 15 to 44 have difficulty getting pregnant or carrying a pregnancy to term. That’s nearly one in five women in the U.S. So it’s likely that you know someone struggling with infertility, whether they choose to share it or not.
- What is In-Vitro Fertilization (IVF)?
IVF (In-vitro fertilization) or test tube baby as it is commonly called is a procedure in which the eggs and the sperms are fertilized outside the body and then transferred back to the womb after 2-5 days.
- Who needs an In-Vitro Fertilization (IVF)?
IVF may be considered if,
- You have been diagnosed with unexplained infertility.
- Your fallopian tubes are blocked other techniques such as fertility drugs or intrauterine insemination (IUI) have not been successful.
- Other techniques such as fertility drugs or intrauterine insemination (IUI) have not been successful the male partner has fertility problems and an abnormal semen analysis.
- The male partner has fertility problems and an abnormal semen analysis.
- You are using your partner’s frozen sperm in your treatment and IUI is not suitable for you.
- You are using donated eggs or your own frozen eggs in your treatment.
- You are using embryo testing to avoid passing on a genetic condition to your child.
- If you have severe endometriosis.
- What do I expect during my test tube baby treatment cycle?
Your IVF/ Test tube baby treatment cycle would be as follows,
Step 1: Once you have decided to go ahead with IVF, you will undergo a daycare procedure called hysteroscopy to assess the suitability of the uterus to hold the baby. It is generally done one month before your IVF cycle and involves the introduction of a small camera into the womb through the vagina to visualize the inside of the uterus. You will be given anesthesia during the procedure and hence there will be no pain.
Step 2: Your husband has to freeze one semen sample as a backup.
Step 3: Typically your treatment would begin on the second or third day of periods. It involves a scan and hormone tests followed by daily injections for about 8-10 days, along with monitoring by scan and hormone tests in between. Once the eggs are sufficiently grown as per the scan and hormone tests, you will receive injection Hcg as an ovulation trigger.
Step 4: Egg retrieval is performed transvaginally 35 – 36 hours later, with light anesthesia, using transvaginal ultrasound guidance. You will be discharged the same evening unless there are problems associated with bleeding, undue pain or ovarian hyperstimulation.
Step 5: After retrieval, eggs are assessed for their maturity. Meanwhile, the husband has to give a fresh semen sample. Mature eggs are injected with the sperms on the same day and grown in the incubator for 3-5 days.
Step 6: The final step is the embryo transfer. 3-5 days after your egg retrieval, two or three embryos are selected and gently transferred into the womb using abdominal ultrasound guidance. The procedure is usually painless, no anesthesia is required and you will be discharged in about two to three hours.
Step 7: You will be given certain supportive medications starting from the day of egg retrieval until your pregnancy check. You will be called for a pregnancy check 16-17 days after your embryo transfer.
- What precautions do I take during the In-Vitro Fertilization (IVF)/ Test tube baby treatment?
- Eat a healthy diet rich in fruits and vegetables
- Be stress-free and relax your mind
- Avoid intercourse during the treatment.
- Don’t do a strenuous job during the treatment as your ovaries are enlarged and they may twist sometimes causing acute pain.
- How do I prepare myself for an egg retrieval procedure?
- You will get admitted to the hospital early in the morning, between 6 am – 7 am and you have to be empty stomach at least 6-8 hours before the procedure.
- You will be administered light anesthesia as intravenous medication.
- The procedure is done vaginally using the scan guidance and a small needle.
- The entire procedure takes about 20-30 minutes.
- Post-procedure you may have slight pain or bleeding which usually subsides with medication.
- You will be discharged about 6 hours later.
- What do I expect during embryo transfer?
It is done 3-5 days following the egg retrieval, which will be decided by your clinician. No anesthesia is required as it is a painless procedure. Rarely during your initial assessment, if it is found that getting into the uterus is difficult or if you are very uncooperative, you may be given light anesthesia. Your bladder has to be full before the procedure as it is done under abdominal scan guidance. Do not wear perfume/ deodorant or powder on that day as they are harmful to the embryos. Two or Three embryos are gently transferred to the uterus using a small catheter. You will lie down for about 15 – 30 minutes after the procedure and later you can pass urine. No need to take bed rest until your pregnancy check. This does not increase your chances of becoming pregnant.
- What is ICSI? How does it differ from In vitro fertilization (IVF)?
ICSI – Intracytoplasmic Sperm Injection, is an IVF procedure in which a single sperm is injected directly into an egg whereas in IVF, about 50,000 to 1,00,000 sperms are inseminated around the eggs and one of them penetrates the egg on its own. ICSI increases the fertilization rates especially in male factor infertility and cases of previous fertilization failure.
- What is the success rate of test-tube baby?
The success rate varies with multiple factors especially the age of the women, egg and the sperm quality and the underlying cause of infertility. Overall the success varies between 40-50 %. Success decreases as the age of the woman increases.
- What is the frozen embryo transfer?
Surplus embryos after your transfer can be frozen and kept in liquid nitrogen at -180 degree Celsius, for later use.
- What are the complications?
Two most important complications of In-Vitro Fertilization (IVF) are
- Multiple pregnancies (20-25%).
- Ovarian hyperstimulation syndrome which occurs due to excessive response and can be prevented b appropriate modifications in the medications.
- Rarely ovaries may twist causing acute pain and may require a laparoscopy.
- When can I know if I have become pregnant?
You will be tested for beta HCG – a blood test to confirm pregnancy 14 to 16 days after your embryo transfer.
There is no evidence to show that IVF babies have an increased rate of abnormalities. The pregnancy outcome will be like a normal conception but your doctor may have a low threshold for intervention when the problem arises.
- Fertility: assessment and treatment for people with fertility problems.NICE clinical guideline;– Issued: February 2013.
- van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F (2010). “Predictive factors In-Vitro Fertilization (IVF): a systematic review and meta-analysis”. Human Reproduction Update 16 (6): 577–589.
Men and women are affected by infertility in different ways.
Most couples experience the struggle in much the same way. This is related to the traditional ways men and women have been trained to think, feel and act. Women are typically seen, by others as well as themselves, as the emotional caretakers or providers of the relationship.
Women typically feel responsible not only for everyone’s bad feelings but also for anything bad that happens. When women try to repress feelings, their emotions can become more ominous until they finally feel out of control. Their emotions can become a monster about to swallow them whole.
Women in infertile couples often protect their husbands from their own pain and feelings of failure by taking much of the responsibility for the treatments upon themselves. When it is suggested that men accompany their wives for appointments, couples get concerned about issues like income loss, use of time, etc. While these concerns are usually relevant and important, they also serve the purpose of protecting husbands from their own responsibility in the conception process and from their own feelings, which could easily be intensified by so much contact with the medical process.
Men are traditionally seen as the financial providers of the relationship and are responsible for protecting the family from real or imagined dangers. Men usually feel more threatened expressing themselves since they have often been conditioned to repress their emotions. They are trained to be more instructional to take charge, to make decisions and to think without being sidetracked by emotions.
Males in infertile couples often feel overwhelmed by the intensity of their partner’s emotions as well as an inability to access their own. They tend to focus their energy back into their work, a place where they feel they can have more success.
Impact of Infertility in Women
As a result of taking responsibility for the emotional impact of infertility, the woman experiences intense feelings, such as pain, anger, fear, etc., which, combined with the messages that her way of dealing with things is in some way dysfunctional or “crazy”, causes her to feel an anxious depression. As feelings spill out, she feels out of control and doesn’t really know how to ask for what she needs, especially from the husband she is struggling so hard to protect. She may yearn for an emotional connection/interaction at one moment and in the next withdraw emotionally from her husband when she fears she has disappointed him.
Men find themselves in a position where, regardless of how well they’ve been trained to solve problems, they are helpless to make this situation better for the woman and, as a result, may give off messages that she is “too” emotional or sensitive, hoping that this will calm her down. The wife hears this as a criticism of her coping and caretaking skills rather than as an expression of her husband’s fears.
This is the time when couples cling together for dear life, feeling that they’ve failed in the most basic of all roles: reproduction. Couples are hesitant to admit problems in their marriage, feeling that having difficulty coping would mean that their marriage is also a failure.
Luckily, there are ways that men and women can help each other balance thinking and feeling as they struggle side by side on their journey toward parenthood.
The questions then arise:
- How do I get what I need from my partner?
- How can I support my partner during this difficult time?
Here are some suggestions to help both partners during the infertility process:
- Communicate openly with each other.
- Realize there’s no right or wrong way to feel. Getting in touch with your feelings will help you know what you need. Once needs are identified, clearly and specifically tell your partner how to help you.
- Ask your partner what she/he needs rather than assuming that you can/cannot give it.
- Recognize the psychological and emotional differences between men and women.
- See if you can teach each other some of the skills you’ve learned from your own life experiences as a man or woman.
- Share more in the process of treatment. Share both the burdens and joys of your different perceptions/experiences of infertility. It will help to balance the intensity and bring you closer with a deeper respect for each other.
1. Prickling, tingling nipples
As pregnancy hormones increase the blood supply to your breasts, you may feel a tingling sensation around your nipples.
This can be one of the earliest symptoms of pregnancy and is sometimes noticeable within a week or so of conception. Once your body gets used to the hormone surge, this sensation will subside.