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Women are born with a fixed number of eggs in the ovary and unfortunately, these eggs dwindle with time. Women are most fertile between 25 to 30 yrs. As they grow older and cross 35 yrs the number of eggs and the quality of eggs decline and thereby decreases her chances of conception.

Women who are in their 30's seeking fertility treatment are usually advised AMH testing which is a blood test to understand a woman's egg reserve and gives us a clue as to what is the time period the woman has for conception.

Women who have low AMH tend to have low numbers of eggs and women with low reserve must conceive at the earliest as with time the ovarian reserve can further go down resulting in lower chances of conception.

AMH testing can be done at any time of the menstrual cycle, it should be done in a reliable validated lab to prevent testing errors. An AMH 2 to 4 ng is considered normal. A value of less than 2 ng is considered low and anything less than 1 ng is very low.

If you have been detected to have low AMH it is important not to panic and stay positive. A lot of women with low AMH do conceive either spontaneously or with some medical help from the treating fertility specialist.

Women more than 35 yrs with low AMH require to be proactive and seek active intervention so that their chances of conception are not hampered. It is important to realize that with time AMH level further declines suggesting a lowering of their egg reserve and thereby affecting their chances of achieving pregnancy.

Women with low AMH should consult fertility specialists and discuss the treatment options available for them to become pregnant.

At SFC, fertility treatment for women with low AMH is individualized depending on their age, duration of married life and since how long they have been trying to conceive. Based on the above parameters couples of treatment options are discussed.

At SFC, women with low AMH apart from the regular IVF treatment are also offered Minimal stimulation IVF and embryo pooling.

PCOS is one of the very common reproductive endocrine problems seen in women seeking fertility treatment. Polycystic ovarian syndrome, the name itself is a misnomer because as such these women do not have cysts in the ovary; they have multiple small follicles that are placed in the periphery of the ovary with dense stroma, and on ultrasound, they appear like a string of pearls.

Women suffering from PCOS have irregular menstrual cycles. Their cycles are usually prolonged and can range from 35 to 45 to even 90 days along with the excessive menstrual flow. Some women do not seem to menstruate on their own and require medication so that they menstruate. PCOS patients may also have unwanted hair growth in areas where normally a woman is not expected to have; for example, over the upper lip and chin. PCOS women also tend to be obese and may have associated derangement blood sugars. A small percentage of the women with PCOS can also have other associated endocrine disorders such as hypothyroidism and hyperprolactinemia.

Reasons for Infertility

Women with PCOS can have difficulty in conceiving as they tend to have anovulatory or oligo ovulatory cycles, which means that women with PCOS may not ovulate at all or may ovulate less frequently compared to women who have regular menstrual cycles, thereby resulting in infertility. Ovulation occurs as a result of the synchronous release of reproductive hormones FSH and LH. This well-orchestrated release of FSH and LH does not seem to occur in women with PCOS, thereby resulting in anovulation. PCOS women also tend to have higher levels of male hormones resulting in hirsutism. These hormonal derangements result in difficulty in conception.

Lifestyle modification

women with irregular menstrual cycles, hirsutism, and obesity must consult fertility specialists so that they receive the correct guidance and treatment.

Women with PCOS need to make appropriate lifestyle changes with regards to their diet and exercise so that their chances of conception improve. Studies have shown that a 5 to 10% weight loss can drastically enhance the chances of conception and also tend to have improved response to fertility treatments.

Fertility Treatments

The usual fertility treatments involve the usage of fertility drugs to make sure the patient ovulates. Ovulation is checked by doing a follicular study and once a dominant follicle is ready to ovulate, the woman is advised to have intercourse with her husband. If she does not respond to the oral fertility drugs the clinician may advise hormone injections to make sure the woman ovulates.

LAPAROSCOPIC OVARIAN DRILLING

Laparoscopic ovarian drilling is done for a select group of PCOS patients who do not respond to fertility drugs or if they have associated tubal block. This is a daycare surgical procedure done laparoscopically and involves puncturing the cysts in the ovary using bipolar cautery.

ROLE OF IUI IN PCOS PATIENTS

IUI is intrauterine insemination of processed semen samples and is indicated if the male partner has low sperm count or low sperm motility or if the male partner has any other associated problem.

ROLE OF IVF IN PCOS PATIENTS

IVF may be required in a small percentage of couples who fail all conservative fertility treatments such as ovulation induction, IUI. It may also be required if the male partner has a very low sperm count or if there is an associated tubal problem.

SFC has vast experience in treating PCOS patients and has a specific protocol for managing its PCOS patients to enhance their chances of conception.

If you are having any of the PCOS symptoms you must consult a fertility specialist and get treated at the earliest.

Pcos is one of the very common reproductive endocrine problems seen in women seeking fertility treatment.

Polycystic ovarian syndrome the name itself is a misnomer because as such these women do not have cysts in the ovary they have multiple small follicles that are placed in the periphery of the ovary with dense stroma and on ultrasound, they appear like a string of pearls.

Women suffering from PCOS have irregular menstrual cycles .there cycles are usually prolonged it can range from 35 to 45 to even 90 days along with the excessive menstrual flow. some women do not seem to menstruate on their own and require medication so that they menstruate.pcos patients may also have unwanted hair growth in areas where normally a woman is not expected to have for eg over the upper lip chin. PCOS women also tend to be obese and may have associated derangement blood sugars. A small percentage of the women with PCOS can also have other associated endocrine disorders such as hypothyroidism and hyperprolactinemia.

REASONS FOR INFERTILITY

women with PCOS can have difficulty in conceiving as they tend to have anovulatory cycles, which means that PCOS may not ovulate at all or may ovulate less frequently compared to women who have regular menstrual cycles thereby resulting in infertility. Ovulation occurs as a result of the synchronous release of reproductive hormones FSH and LH, this well-orchestrated release of FSH and LH does not seem to occur in women with PCOS, thereby resulting in anovulation.PCOS women also tend to have higher levels of male hormones resulting in hirsutism. These hormonal derangements result in difficulty in conception.

LIFE STYLE MODIFICATION

women with irregular menstrual cycles hirsutism and obesity must consult fertility specialist so that they receive the correct guidance and treatment.

Women with PCOS need to make appropriate lifestyle changes with regards to their diet and exercise so that their chances of conception improve.studies have shown that a 5 to 10 %weight loss can drastically enhance the chances of conception and also tend to have improved response to fertility treatments .

FERTILITY TREATMENTS

The usual fertility treatments involve usage of fertility medications to make sure the patient ovulates.ovulation is checked by doing a follicular study and once a dominant follicle is ready to ovulate, the women are advised to have intercourse with her husband. If she does not respond to the oral fertility drugs the clinician may advise gonadotrophin injections to make sure the women ovulate.

LAPROSCOPIC OVARIAN DRILLING

Laproscopic ovarian drilling is done for a select group of PCOS patients who do not respond to fertility drugs or if they have associated tubal block. This is a daycare surgical procedure done laparoscopically, which involves puncturing the cysts in the ovary using bipolar cautery.

ROLE OF IUI IN PCOS PATIENTS

IUI is intrauterine insemination of processed semen samples and is indicated if the male partner has low sperm count or low sperm motility or if the male partner has any other associated problem.

ROLE OF IVF IN PCOS PATIENTS

IVF may be required in a small percentage of couples who fail all conservative fertility treatments such as ovulation induction, IUI. It may also be required if the male partner has a very low sperm count or if there is an associated tubal problem.

SFC has vast experience in treating PCOS patients and has a specific protocol for managing its PCOS patients to enhance their chances of conception.

If you are having any of the PCOS symptoms you must consult a fertility specialist and get treated at the earliest.

IVF, commonly known as test tube baby, is as we all know an advanced fertility treatment done to help couples overcome infertility and become parents.

In-vitro fertilisation is a complex procedure which involves extracting eggs from a woman's ovary and fertilising them with her partner's sperm, followed by transfer of the resulting embryo into the woman’s womb. Not all couples seeking fertility treatment will require IVF, only a small subset will require this treatment.

The following are some of the indications for IVF treatment

• Women with bilateral tubal blockage
• Women with severe endometriosis
• Resistant PCOS patient or PCOS patients who failed to conceive with ovulation induction cycles and IUI treatments
• Unexplained infertility of more than 5 years period
• Women with low egg reserves who do not seem to have a lot of time in their hand
• Women with cancer prior to their chemo or radiotherapy
• Male partners who have low sperm count
• Couple with disorders requiring PGD
• Women with recurrent pregnancy loss requiring PGT-A

At SFC, we follow strict criteria for the selection of couples for IVF treatment, and treatment is done only if they meet the criteria.

Every couple who are undergoing IVF would want a successful outcome, it is also very well known that not all of them have a positive outcome.

Some couples have better chances of a successful outcome when compared to others.

Women tend to have a better outcome if she is less than 35 yrs and married for less than 5 yrs, has a good ovarian reserve and if she is undergoing IVF for a tubal block or for mild to moderate male factor subfertility.

Women who are aged 35 and above and married for more than 5 yrs with low ovarian reserve, severe endometriosis, and severe male factor subfertility tend to have poorer prognosis.

Choosing an IVF clinic which is having an experienced team of clinicians and embryologists with an accreditated well equipped IVF laboratory is of utmost importance to have the best chances of a positive outcome.

All couples trying to conceive through IVF should discuss with their fertility specialist their chances of conception and discuss with the clinician the treatment options available to improve their chances of conception.

Couples who are trying to conceive are very anxious and stressed and also confused about whom to approach for their fertility treatment. Choosing the right doctor is crucial so that the couple receives correct guidance advice and treatment.

When choosing your doctor the following aspects can be considered. The clinician should be specialized and adequately experienced in managing infertility.

The clinician should share with you all the information transparently related to your condition.

The clinician should be approachable and communicative .

The center where the clinician is attached should have a well-equipped laboratory and OT with an in-house embryologist.

The IVF success rate of the center should be on par with the current standards.

The center should be accreditated by the local authorities.

We are happy to inform all our patients that SFC is an accreditated IVF center with an in-house embryology team, lead by an experienced and trained fertility specialist Dr. Sunitha Ilinani. SFC has been ranked among the top 3 clinics in Hyderabad and consistently giving a 45 to 50 % success rate in IVF treatments.

At SFC doctors and nursing staff are committed to patient care and will guide you at every step of your fertility evaluation and treatment.they will patiently listen to your problems and are willing to answer all your queries during treatment.

Couple seeking to consult for fertility treatment are advised to take prior appointment so that they do not have to wait for their turn. You are requested to get all your previous reports so that the doctor can thoroughly understand the reasons for failure to conceive. On your first visit, a detailed history is taken and the doctor will review all your tests and treatments. Hormonal evaluation and routine blood tests are ordered, it is our clinic policy not to overburden our patients with too many tests, so only what is necessary is done. If you do have blood tests reports done in the recent past they will be considered .

A detailed transvaginal pelvic ultrasound is done to assess the women's ovarian reserve and rule out any anatomical and pathological defect in the uterus. Also, a vaginal culture swab and pap smear are done at this time.

It is also mandatory to evaluate the male partner, a semen analysis is advised with a minimum of 3 days and a maximum of 5-day abstinence. Here we would like to reiterate that semen analysis is a very important test and at SFC we use computerized semen analysis testing to remove any element of human error.

Once the preliminary workup is done further evaluation will depend on the hormonal ultrasound and semen analysis report.

You will require two visits to the clinic to complete the preliminary evaluation. Tubal assessment for the female partner is done by HSG or saline sonohysterography. This test is usually done between day 6 to day 10 of the menstrual cycle.

Patient may be advised hysteroscopy and laparoscopy depending on the ultrasound and HSG findings Hysterolaproscopy is advised in patients with a tubal block on HSG, endometriotic ovarian cyst, fibroids, endometrial polyps, etc.

At SFC couple will require two visits to the clinic to complete preliminary evaluation.

It is advisable to plan your first visit either on day 2 or 3 of the menstrual cycle or in the midcycle day 12 to 14 so that workup is completed with minimal visits to the clinic.

Mrs. S aged 32 and Mr. S aged 33 married for 5 yrs have approached us for IVF treatment. The couple had already undergone IVF treatment at a reputed center with no result. Mrs. S had two fresh embryo transfers and 3 frozen embryo transfers of the good quality blastocyst with no positive outcome. Having undergone repeated embryo transfers with no positive outcome, they were quite anxious and wanted to know what are the treatment options available for a positive outcome.

We explained to the couple that the reasons for IVF failure could be chromosomally abnormal embryo, the other factor could be that the embryos are being transferred at the wrong time, meaning that they are either transferred before or after the window of implantation failing and this can be assessed by doing ERA test.

As discussed an ERA test was done and the test results showed that the endometrium was pre receptive and embryo transfer should be done earlier than what is being routinely followed for a positive outcome.

After detailed counseling the couple were taken up for the IVF cycle. There were 5 good quality blastocysts and all of them were frozen. A planned frozen embryo transfer was done based on the ERA test results. A single good quality embryo was transferred four and a half days after starting progesterone.

Fifteen days after the embryo transfer pregnancy test was done and the results confirmed pregnancy.

Repeat IVF failures are challenging cases and should be dealt with utmost care. A positive outcome can be expected with the appropriate use of advanced investigations and technology.

SFC has the expertise and advanced ART treatment to help couples with repeated IVF failures in achieving their dream of parenthood.

Mrs d and Mr g aged 28 and 32 respectively visited the centre for fertility evaluation.

Couple have been married for 2 yrs and have been trying to conceive since one year.

Routine evaluation as per standard protocol was carried out which included an ultrasound and hormone tests for the lady and a semen analysis for the male partner.

The semen analysis revealed the sperm count as 0.5 million with only 20%motility and 1% normal morphology. This is considered as very low sperm count ,normal count as per WHO standard should be more than 15 million. Patient was advised to repeat the semen analysis after 15 days, a second report done after 15 days also showed similar low sperm count.

Patient was advised to consult in-house male infertility specialist for opinion regarding further evaluation and treatment.

Patient was advised hormonal ultrasound evaluation to understand the reason for the low sperm count.

The evaluation revealed ap very high FSH value around 20 suggestive of impending testicular failure. Patient was advised to immediately freeze the semen sample .

Couple couple were counselled for IVF ICSI where eggs are collected from the female partner and sperm is then injected into each each healthy mature egg. ICSI is intracytoplasmic sperm injection, it is an advanced fertility teatment and especially useful in couples where male partner has very low sperm count and it is impossible to get pregnant naturally given the low sperm count. Female partner was given gonadotrophin injection so that multiple eggs grow which were then collected via transvaginal ultrasound guidance, the collected eggs were then screened by the expert embryology team and in each mature egg sperm was injected.

The procedure resulted in 4 grade 1 embryos, two embryos were transferred and two were frozen for future use.

We are happy to note that couple had a successful pregnancy.

ICSI for extremely low sperm count is advanced fertility treatment and when done by expert embryology team can help couples to achieve pregnancy.