Infertility Treatment in India

Overview

Generally, worldwide it is estimated that one in seven couples have problems conceiving, with the incidence similar in most countries independent of the level of the country's development. Infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

What is Infertility?

Infertility primarily refers to the biological inability of a person to contribute to conception. A condition in which a couple has problems conceiving, or getting pregnant, after one year of regular sexual intercourse without using any birth control methods. Infertility can be caused by a problem with the man or the woman, or both. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term.

Causes of Infertility

The normal reproduction process requires interaction between the female and male reproductive tracts. The woman ovulates and releases an egg from her ovaries to travel through the fallopian tube to her uterus (womb). The male produces sperm. Both egg and sperm normally meet in the woman's fallopian tube, where fertilization occurs. The embryo then implants in the uterus for further development. Infertility occurs when something in this pattern does not happen. The problem could be with the woman, with the man, or with both. Common causes of infertility (both in men and women) are as follows:

• Ovulation problems
• Tubal causes
• Sperm causes
• Unexplained infertility
• Age-related factors

In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.

Types of Infertility

There are many types of infertility which could be summed up in the following ways:

• Primary Infertility: - Primary infertility is a term used to describe a couple that has never been able to conceive a pregnancy after a minimum of one year of attempting to do so through unprotected intercourse.
  
  
• Secondary Infertility: - Secondary infertility is usually defined as the inability to conceive or carry a pregnancy to term after successfully and naturally conceiving one or more children. 
  
  
• Subfertility: - Infertility that is not “absolute', or “complete infertility” that is, there is a chance of pregnancy, but the chance of getting pregnant each month is reduced. A less than normal capacity for reproduction is called as subfertility.
  
  
• Male Infertility: - Male infertility refers to infertility in male humans. Being infertile has nothing to do with male sexual prowess (virility), but rather with the absence of healthy sperm in the semen that are capable of traveling to meet the ovum.
  
  
• Female Infertility: - Female infertility refers to infertility in female humans. Infertility in a couple that relates to factors associated with the woman rather than the man. For a woman to be fertile, her reproductive organs must be healthy and functional.

Diagnosis

After 12 months of trying to conceive you should consult your GP or gynecologist for a referral to a fertility specialist. You and your partner will undergo a series of tests – sometimes your GP may conduct these tests. The test results will give clues to the type of infertility and ultimately a treatment plan to overcome the problem. Firstly, the specialist will look at the couple's medical history. For the woman, this includes information on any previous pregnancies, the regularity of her periods; and whether she has had painful periods, pelvic pain, infections, or surgery. A specialist will want to know if the man has previously fathered children, suffered a testicular injury; or had any developmental problems, infections, surgery; or if he has been exposed to certain environmental factors. Next there will be a physical examination, which may include:

• Blood Tests: A series of tests will establish if there is a hormonal basis for the couple's infertility – this may be corrected by hormonal supplements. Other tests will check for rubella, blood group, sperm antibodies and sexually transmitted diseases such as HIV, Hepatitis B and C.
  
  
• Ultrasound Examination: This gives information on what the ovaries and uterus look like. Your doctor will look at the growth of eggs, the thickness of the lining of the uterus (if thin, it can indicate hormonal problems), the presence of fibroids or polyps on the uterus, as well as signs of endometriosis or ovarian cysts. Surgical laparoscopy may also be used to identify endometriosis or blocked fallopian tubes.
  
  
• Semen Analysis: Men need to provide a semen sample this allows specialists to assess the number of sperm, how well they swim (known as 'motility') and the presence of sperm antibodies.

Some of the Common Treatments used for Infertility

Infertility treatments can be grouped into three categories:

• Medicines to Improve Fertility
• Surgical Treatments
• Assisted Conception

Each of these is discussed briefly below.

• Medicines (drugs) that may Improve Fertility:

Medicines are mainly used to help with ovulation. Ovulation is when the ovary makes and releases an egg (ovum). Ovulation should occur about once a month in women up until the menopause. For various reasons, ovulation may not occur at all, or it may occur less often than normal. Ovulation is partly controlled by hormones called gonadotrophins. These are made in the pituitary gland (a gland just under the brain). A gonadotrophin is a hormone that stimulates the activity of the gonads (the ovaries in women, and the testes in men). The main gonadotrophins made by the pituitary gland are called follicle-stimulating hormone (FSH) and luteinising hormone (LH). These pass into the bloodstream and travel to the ovaries.

• Clomifene: is a medicine that has been used to help with fertility for many years. It is taken as a tablet. It works by blocking a 'feedback' mechanism to the pituitary gland.
  
  
• Medicines that contain Gonadotrophins: are another type of treatment. These need to be injected and tend to be used when clomifene does not work, or prior to IUI and IVF to cause ovulation.
  
  
• Medicines that contain Gonadotrophin-releasing Hormone: are sometimes used. These stimulate the pituitary to release gonadotrophins (which in turn stimulate the ovaries).
  
  
• Metformin: may be offered to women with polycystic ovary syndrome who have infertility and who have not responded to clomifene. Metformin is a medicine that is commonly used to treat some people with diabetes.

Make sure you have a full discussion with your doctor before taking any medicine for infertility. This is so that you are aware of success rates, any potential side-effects or risks (see below) and also the latest research and evidence for these medicines.

• Surgical Treatments

The situations where surgery may be an option include:

• Fallopian Tube Problems - Surgery to the fallopian tubes may help some women with infertility caused by fallopian tube problems. For example, if your fallopian tubes have been blocked or scarred from a previous disease, infection, or other problem. Some women who have had a 'tubal tie' (sterilisation) in the past for contraception may be able to have their fertility restored by tubal surgery. These days, most surgery to the fallopian tubes is done by 'keyhole' surgery.
  
  
• Endometriosis - Surgery may help to improve fertility in  women with endometriosis.
  
  
• Polycystic Ovary Syndrome - A special operation on the  ovaries may be suitable for some women with polycystic ovary syndrome. The procedure is sometimes called 'ovarian drilling' or 'ovarian diathermy'. Using keyhole surgery, a heat source (diathermy) is used to destroy some of the follicles (tiny cysts) that develop in the ovaries. It is usually done if other treatments for polycystic ovary syndrome haven't worked.
  
  
• Fibroids - For women with fibroids, sometimes surgery to remove the fibroid may be considered if there is no other explanation for the infertility. However, whether fibroids do cause infertility, and therefore whether they should be removed, is still uncertain.
  
  
• A Cause of Male Infertility - One cause of infertility is due to   sperm being blocked by an abnormality in the epididymis in the testis. This may be treated with surgery.

An operation used to be thought to help men who had a varicocele (like 'varicose veins of the testes') and who were infertile. However, a recent study has concluded that surgery is not likely to help in this situation. See separate leaflet called 'Varicocele' for further details.

• Assisted Conception

Current techniques are described briefly below. Your specialist will advise on which techniques are options for your particular cause of infertility, and explain the chance of success.

1. Intrauterine Insemination (IUI): This is the process by which sperm is placed in the woman's uterus. It is done by using a fine plastic tube which is passed through the cervix into the uterus. Sperm are passed through the tube. It is a relatively straightforward procedure. It can be timed to coincide with ovulation (about half way through a monthly cycle) in women who are still ovulating. Fertility medicines may also be given beforehand, to maximize the chance of ovulation occurring. Women who have this procedure need to have healthy fallopian tubes to allow the egg to travel from the ovary into the uterus. If successful, fertilization takes place within the uterus.
   
   
2. In Vitro Fertilization (IVF): In vitro fertilization means fertilization outside of the body. In vitro literally means 'in glass' (that is, in a laboratory dish or test tube). IVF is mainly used in couples whose infertility is caused by blocked fallopian tubes, or unexplained infertility. IVF involves taking fertility medicines to stimulate the ovaries to make more eggs than usual. When the eggs have formed, a small operation is needed to get them ('egg retrieval'). Each egg is mixed with sperm which is obtained in the same way as for IUI (described above). The egg/sperm mixture is left for a few days in a laboratory dish (often referred to as a 'test tube'). The aim is for sperm to fertilise the eggs to form embryos.
   
   
3. Gamete Intrafallopian Transfer (GIFT): A gamete is an egg or sperm. Eggs and sperm are collected in the same way as for IVF. The eggs are mixed with sperm. The mixture of eggs and sperm are then placed into one of the woman's fallopian tubes. Therefore, unlike IVF, the sperm fertilises the egg 'naturally' inside the woman's fallopian tube or uterus, and not outside the body in a laboratory dish. For this to work, the woman's fallopian tube needs to be healthy. GIFT has been used in cases of 'unexplained fertility' or male factor infertility problems. However, it does not seem to be any more effective than IVF and so is not so commonly used.
   
   
4. Intracytoplasmic Sperm Injection (ICSI): This technique involves an individual sperm being injected directly into an egg. (It is injected into the cytoplasm - the outer part of the egg.) This method bypasses any natural barriers that may have been preventing fertilisation. For example, some cases of infertility are due to the sperm of a male partner not being able to 'penetrate' the outer part of the egg to fertilise the egg. ICSI can also be used when a male partner has a low sperm count as only one sperm is needed. If needed, a sperm can also be obtained by a small operation to the testis. This may be done when sperm cannot be produced in the usual way (for example, if the male partner has a blocked vas deferens, or has had a vasectomy).
   
   
5. Egg Donation: This involves stimulating the ovaries of a female donor with fertility medicines, and collecting the eggs which form. The eggs are mixed with and fertilised by sperm of the recipient's partner (similar to IVF). After 2-3 days, embryos are placed in the uterus of the recipient via the cervix. This method is an option for: women who have ovarian failure and cannot produce eggs; who have had their ovaries removed; who have conditions where the ovaries do not work (for example, Turner's syndrome); where there is a high risk of transmitting a genetic disorder to the baby. It is also used in certain cases of IVF failure.
   
   
6. Embryo Donation: Couples who have had successful IVF treatment may decide to donate any spare embryos to help other infertile couples.
   
   
7. Treatment for Unexplained Infertility: It tends to include either stimulation of ovulation using clomifene, intrauterine insemination or in vitro fertilisation. A recent study in Scotland looked at treatments for unexplained infertility including treatment with clomifene or treatment with intrauterine insemination. It compared these two treatments to no active treatment (that is, to couples just continuing to try to conceive naturally) over a six month period.

Other Treatments: Some people suggest that supplements including zinc, selenium, and vitamin E supplements may be helpful for men who have abnormal sperm counts due to an unknown cause. However, the evidence to support the use of such supplements is a little weak.

Life after Infertility Treatments

If you are one of the many couples who have been lucky enough to conceive then congratulations on your pregnancy. The feelings of happiness and excitement will make up for the months or years of heartache and despair.

• There will have been times when you wondered if all of this treatment was worth it but the main thing is that you have become pregnant which has made all of it worthwhile. Even the constant tests, scans and monitoring your monthly cycle!
  
  
• This is not the end of it as your next concern is the pregnancy itself. It is entirely normal to worry that things might go wrong but many women experience this and that’s without undergoing any fertility treatment. Most pregnancies run smoothly and there’s no reason why yours shouldn’t be one of these.
  
  
• There are risks and complications with pregnancy which apply to all women, but you will be cared for throughout this time by a team of healthcare professionals. Keep it up with your regular antenatal checks and you will be advised about having a healthy diet, taking exercise and avoiding alcohol and cigarettes.
  
  

Benefits of Infertility Treatment

The benefits of fertility treatment far out way the risks attached to it. Obviously the main benefit is to conceive with a child, and I suppose this all depends on what treatment you need to help you conceive. The benefits include:

• The primary benefit is that this technique allows couples that are infertile to have children
  
  
• Availability of more effective therapies and treatment options
  
  
• Lessening of social stigma attached to infertility
  
  
• The embryos can be stored, thus allowing their use at a later date. This can be very advantageous in certain situations, for example a woman who must undergo radiation treatment of her ovaries, before she has had her children
  
  
• Higher success rate of pregnancy
  
  

Infertility Treatment in India

Infertility treatment in India has become the most promising infertility treatment destination for a wide range of international tourists coming from all the corners of the world. It is not only within their budget, but also is available with high international class surgical facilities with quick medical appointments, plus medical care and service operations at the hands of experienced infertility treatment experts is attracting many patients and infertile couples from, USA, South Africa, Europe, East Asia and Canada.

Indian healthcare and infertility clinics have guided all global patients and childless couples in a fine way to get them cured from various kinds of male and female infertility disorders. The quality of medical treatment and healthcare amenities in India is absolutely fine plus Indian doctors and medical staff set the fulfillment of patient’s expectations as their primary target.

India has one of the most advanced centres for infertility evaluation, establishing reproductive health and assisted fertilization services in the country today "where patients come first”. In a relaxed, caring and supportive environment the patients get customized solutions. Here, they are understood well the sensitive emotions involved in the fertility treatment and ensure complete privacy during and after the treatment.

Our team of internationally trained and experienced fertility specialists, embryologists, gynecologists, anthologists, holistic medicine experts, gynae-oncologists, legal counselors, psychological counselors and other skilled clinical staffs guide the couples facing difficulties in conceiving, and provide comprehensive solutions to help them achieve healthy parenthood. The following are the Indian cities which render high end infertility treatments:

Cost of Infertility Treatment in India

Being infertile can be very expensive! Tests and treatment cost considerable money, and since there is no definite endpoint, budgeting for medical expenses can be very difficult. However, the cost budget for procedures of Infertility treatment in India is quite friendly along with the presence of robust medical rehabilitation facilities being provided to patients that make them feel at home.