When To Not Delay IVF - Dr. Sudha Tandon's Fertility Blog

When to not delay IVF

delaying ivf treatment

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!

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We are happy to have treated more than 20,000 couples with fertility issues. IUI is simple treatment for couples with unexplained Infertility, PCOS, early endometriosis Know More

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Indicated in couples with tubal blockage, repeated failed IUI and endometriosis. Results range across 40 -50% at our centre Know More

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Treatment of choice for male infertility with very low sperm count, obstructive azoospermia and for coupes requiring donor eggs. Know More

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Many young men and women have utilized our fertility preservation services in the form of sperm, egg and embryo freezing either for medical or social reasons Know More

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Hysteroscopy has many advantages over traditional D & C. We are equipped with small telescope to diagnose and treat pathologies inside the uterine cavity Know More

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Fibroid causes infertility, pain and excessive menstrual blood loss. They can be operated through Laparoscopy or Hysteroscopy Know More

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Our Doctors

Dr. Sudha Tandon

MD. DGO.,

Gynaec Endoscopy Surgeon Fertility and IVF Consultant

Dr. Aditi Tandon

M.S. Obgy,

Fellowship in Reproductive Medicine and IVF (London), Minimal Access Surgery and Ultrasound

Dr. Amrita Tandon

MS, DNB Obgy,

Fellowship in Reproductive Medicine and IVF (London), Minimal Access Surgery and Ultrasound

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Any Queries?

What is infertility ?

If the couple has regular intercourse, does not use any contraception and still does not conceive within one year, they are said to be infertile. 80-85% of the couples conceive within one year of unprotected intercourse i.e. without the use of any contraceptive. However, the rest 15-20 % who are unable to conceive naturally are said to be infertile and these would require proper evaluation and help for getting pregnant.

Does fertility depend on age?

Yes, in a woman fertility does depend on her age. A young woman is naturally more fertile as she has more number of good quality eggs than a woman who is 35 +. Hence a woman who is 35 + should not wait for a long period for a natural conception and should seek help from a proper fertility expert. Also the chance of genetic abnormalities and medical complications like Hypertension and Diabetes increases with age.

When should a couple seek medical help for infertility?

If the woman is below 35 years and has normal menstrual periods, and the couple has tried for a conception for a year with a frequency of sexual intercourse 3-4 times a week during the fertile period and has yet not conceive, then they need to consult an Infertility expert.

How does body weight, diet & exercise affect fertility?

For increasing the chance of pregnancy, balanced body weight of the woman would be beneficial. Being obese or grossly underweight affects the maturation of eggs in the woman and hence may affect her fertility. Also, a grossly obese woman would have mechanical difficulty in having normal sexual relations. Regular, moderate exercise especially in the form of yogasanas, walking, swimming, or jogging prove beneficial for fertility. It has been observed that strenuous form of exercises for example jogging over 3 miles a day can hamper ovulation and hence may lead to decrease in fertility in the woman. Balanced and nutritious diet help increase the chances of conception and ensure proper growth of the fetus.

Is stress a major factor in infertility?

Chronic stress may interfere with the ovulation, may decrease the sexual desire and hence affect the frequency of sexual intercourse in the couple.

How would one know the cause of infertility?

A detailed history of both partners is very helpful in giving a clue to the cause of infertility. For e.g. anovulation is the cause of infertility in a woman who has irregular periods and who is also obese, blocked fallopian tubes in a woman with previous history of pelvic infection, low sperm count in a man with past history of mumps. Examination of both the partners, and getting the required investigations would give a complete picture.

What are the most stressful stages of IVF?

A natural conception is obviously what all couples desire and wish when they plan a pregnancy but when it does not happen and the couple is counselled for an IVF treatment, it creates lots of stress for them.

The most stressful part is the acceptance of the fact that IVF is the only best option for their problem. A good discussion with the doctor to understand about Human Reproduction and why IVF is the best option for them to conceive will help the couple .They should take their time to understand about what the treatment involves and always ask questions to get their doubts cleared. A session with the counsellor would definitely help. Speaking to friends and family who are knowledgeable is a good way to reduce the stress but at times it could be counterproductive especially if they only talk of the problems and are themselves not positive.

In an IVF treatment, the woman’s eggs and her partner‘s sperms are fertilised in a laboratory. To get her eggs, she needs to take hormonal Injections on a daily basis and at the same time every day. This could create some stress especially if she is in a demanding job. It is best that she confides in someone who is reliable and understands the intricacies of an IVF treatment. The best part is that these Injections are not painful as very fine needles are used and she could also self-administer it.

She needs to see her fertility specialist for the follicular tracking for about 4-5 times in a cycle. This could also be demanding and stressful. She should just take all this in her stride and not get unduly stressed. The follicular response may not be satisfactory especially in a woman with poor ovarian reserve and she could become stressed.

She could have stress on the day of egg retrieval because of the fear of pain but this is a small procedure which is done under safe anaesthesia. The procedure is done through the vagina and there are no cuts on her abdomen. This is simple and safe procedure, not painful. At times the male partner gets stressed and is unable to give his semen sample on the day of egg pickup. To avoid this problem, almost all fertility centres will freeze the semen sample beforehand as a backup.

Of course the other stressful point is to worry about the numbers and quality of eggs got at the time of pickup, the fertilization of the eggs, and the numbers of good quality embryos. All these are important form success point of view. A communication with the couple before the procedure will allay all their fears and will go a long way in taking care of the stress.

The most important step in IVF Treatment

The most important step in IVF is Embryo transfer for which the woman should relax. Generally it is done without anaesthesia. The woman‘s cooperation is so very important for favourable results.

After the embryo transfer one has to wait for about 10 days to know the results. It could be very stressful at this stage. She should try to be calm and not just keep thinking of the results. After the embryo transfer the woman has to use either progesterone vaginal tablets or Injections and the stress of finances adds to the stress of procedure.

All in all we do understand the stress that the couple undergoes for an IVF treatment cycle. Have trust in your doctor and you would definitely become a successful.

At our IVF Clinic in Mumbai and IVF centre in Navi Mumbai, we spend quite a lot of time to make you feel comfortable. Our entire support staff and our embryologist are in constant touch with the couple. We try to see that you do not have to wait for too long to see the doctor. We have all facilities of Hysteroscopy/ Laparoscopy / IVF treatment and Maternity at Dr Sudha Tandon centre and we take utmost care of our patients.

Mumbai Centre
Dr. Sudha Tandon's Fertility & IVF Center

4th Floor, Gagangiri Complex 18th Road, Near Dr. Ambedkar Udyan Chembur (E). Mumbai 400 071.

+91 91676 80410 / 022 25260390 / 022 25260391

Navi Mumbai Centre
Dr. Sudha Tandon's Fertility & IVF Center

6, Archana CHS, Gr. Floor, Sector 17, Plot No. 18, Vashi, Navi Mumbai 400 703.

+91 98330 44930 / 022 27802188