Dr. Nalini Bagul


The term Infertility is defined as the inability to conceive despite regular and unprotected intercourse for 1 year.

Insemination refers to the placement of washed and prepared sperm into the uterus in an attempt to achieve pregnancy, using semen from the male partner or from a donor.

For men

  • Ejaculation failure [ because of diabetes, multiple sclerosis, spinal cord injury and retrograde ejaculation, psychological
  • Low sperm count
  • Poor sperm quality
  • Anti Sperm Anti bodies
  • Freezing of semen for future IUI use [for the men who is undergoing vasectomy, chemotherapy or radiotherapy] when husband is away.

For Women

  • Mild endometriosis
  • Cervical mucus hostility

Combined factor

  • Unexplained infertility

Indication for Donor Insemination [DI]

  • For single women
  • When other treatments for male factor infertility are not possible or were unsuccessful[ICSI,Varicocele repair etc]
  • When the male partner is a carrier of undesirable hereditary disease
    When couple cannot afford IVF – ICSI

The blood pregnancy test is performed 12th day after the embryo transfer. If positive, patient is asked to repeat the blood test and ultrasound to ensure successful pregnancy by visualizing foetal heart beat on 30th day after embryo transfer. A good antenatal care is required for a successful pregnancy. We have all the facility for that.

If pregnancy test shows negative result, couple can wait one or two complete menstrual cycles before beginning another ART cycle. Some times tests are required, that may delay subsequent cycles.

The miscarriage rate is about the same for ART as the general population. Since for ART patients we observe foetal sac in early stage, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages probably go unnoticed in the general population

Spermatogenesis or sperm production cycle takes about 3 months time. Sperm quality on the egg retrieval day is often related to what happened in the male’s body 3 months ago. Listed below are some guide lines to help ensure that semen specimen on oocyte pickup day is of best possible quality:

Spermatogenesis or sperm production cycle takes about 3 months time. Sperm quality on the egg retrieval day is often related to what happened in the male’s body 3 months ago. Listed below are some guide lines to help ensure that semen specimen on oocyte pickup day is of best possible quality:

A fever more than 101°C within 3 months prior to ART treatment may adversely affect sperm quality. Sperm count and motility may appear normal, but fertilization may not occur. Body temperature should be maintained below 100 °C with medicines during or before ART cycle.

Any other medicine use should be brought into notice of fertility specialist doctor.

Avoid hot tubs, spas, jacuzzis, or saunas during 3 months prior to ART cycle.

Avoid heavy exercise. Physical activity at a moderate level is acceptable and encouraged.

Refrain from ejaculation for 2-3 days, but not more than 5 days prior to semen collection on oocyte pick up day.

Yes, woman can also be a mother after a tubal ligation operation. We offer two procedures:

Tubal Recanalization: This minor surgical procedure is done on outpatient basis with a success rate of about 80%.

IVF-ET: In this procedure eggs are fertilized outside the body and resultant embryos are transferred to the uterus, thus bypassing the fallopian tube.

A single healthy pregnancy is the goal of any fertility clinic. The multiple birth rate depends on age, uterine condition, embryo implanted and quality of embryos. In our clinic 30% is twin pregnancy rate and 3% higher order birth rate.

Assisted hatching [AZH] is a form of embryo micro manipulation that involves the creation of an opening in the outer covering called zona pellucida of the embryo. The procedure helps a normal, growing embryo hatch from the covering and implant in the uterus. This procedure increases the implantation rate. This thinning of zona can be done by three different ways chemical hatching, mechanical hatching and the latest is with diode laser technique.

Many scientific studies demonstrated a dramatic increase in sperm DNA fragmentation in obese man, leading to the significant reduction in sperm quality. There may be an increase in the miscarriage rate for men with high-level fragmented DNA damage.

Polycystic ovarian syndrome is a problem caused by having abnormal levels of certain hormones in womans body. In PCOS, ovaria are larger than normal and there are a series of underdeveloped follicles that appear in clumps. If these cysts cause a hormonal imbalance, a pattern of symptoms may develop, which is called syndrome. These symptoms are the difference between suffering from polycystic ovary syndrome and from polycystic ovaries. PCOS is the name given to a metabolic condition in which a woman will have symptoms that reflect imbalances in reproductive and other hormones.

Increased sperm DNA fragmentation due to oxidative stress may be due to many reasons – age more than 50 years, smoking, heat exposure, obesity and environmental toxins. Some of these sperm DNA fragmentation may be reversed. Use of antioxidants may improve sperm count, motility and possibly morphology before an IVF cycle.

POF is a loss of ovarian function in women under 40 years, when monthly periods stop and estrogen level is low, which causes menopausal symptoms. The cause for POF includes autoimmune conditions or genetics. POF can be permanent, temporary or periodic and there may be residual ovarian function. Some women with POF may intermittently produce estrogen and even ovulate spontaneously or with the help of potent fertility drugs. Our doctors will guide you on the options for fertility treatment.

WHO [World Health Organiszation] has established six semen parameters for semen analysis and they are:

sperm concentration


overall motility



total motile count

High level of stress in women may cause disturbances of ovulation, and in men impaired sperm production. Stress reduction will help to cope up with infertility. Suggestion for stress reduction will be open talk with partner, exercising regularly , stress relieving activities such as yoga or meditation , avoiding excessive intake of caffeine or other stimulants and to take emotional support from relative or friend.

Pre cycle tests are some blood tests and scanning, which can be done at any infertility clinic with minimal discomfort. Once you are already to start the IVF process you have to take few medicines and injections. Injections are administered subcutaneous with a short needle and discomfort should be tolerable. Only progesterone injections are given intra muscularly.

The main procedure involved in IVF is the egg retrieval and this is performed through the vagina with ultrasound and a fine needle. Patients at our centre are asleep during this procedure and are cared for by a team of anesthesiologists. Patients have no pain with this procedure and they wake up very quickly with the egg retrieval lasting 10-15 mins. The embryo procedure is again a very simple one. A very light anaesthesia is required when there are specific problems with the cervix

A female foetus starts out with more than one million immature eggs and this number decreases steadily so that at the time of puberty, there are approximately 200, 000 eggs remaining in the ovaries for future ovulation. Many eggs are recruited each month but in a natural cycle only one egg matures. Menopause refers to the time when all viable eggs have been used up and this generally occurs in the mid to late 40S. The biological clock therefore refers to the time starting with puberty and ending with menopause during which the number of eggs decreases steadily. As a women approaches menopause, the ovaries become more resistant to stimulation producing fewer eggs that they did in the years before. For some women this ovarian resistance can start in the 30s and even occasionally in the teens and early 20s. There are number of ways of estimating ovarian reserve – the most common is to measure the FSH and LH on the second or third day of the menstrual cycle. An FSH level over 10 suggests the onset of ovarian resistance.

For women above forty years chances of getting pregnant by their own egg decrease if the base line FSH is less that 11 miu/ml. Secondly, their embryos need assisted hatching to increase the chances of implantation. Lastly, but most important, women above 40 should go for Pre Implantation Genetic Diagnosis (PGD) as at these age higher percentage of chromosomal abnormalities and mutation in gene observed. The other simple and safe option is “egg donation” by any younger lady.

Fibroids are benign tumours consisting of fibrous tissue and muscle which grow in the uterus. The significance of fibroids relates to not only their size but also their location. Even small fibroids located inside the cavity of the uterus where embryos need to implant, may interface with success and need to be removed. Fibroids that do not encroach on the cavity of the uterus are generally not significant unless they are larger than 5 cm in diameter and also if there are many fibroids causing significant uterine enlargement.

During egg retrieval, you’ll be sedated and given pain medication. Transvaginal ultrasound aspiration is the usual retrieval method. … Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs.

For each cycle of in vitro fertilization: Using her own eggs, a woman’s chances ofhaving a live birth decline from over 40% in her late 20s, to 30% at about age 38, and to 10% by about age 43. Live birth rates are about the same among younger and older women using donor eggs.

During these two weeks, your ovaries will be stimulated to produce follicles, ovulation will occur and thereafter an insemination is performed. In vitro fertilization (IVF), takes a bit longer, lasting anywhere from 4-6 weeks prior to egg retrieval. The embryos are then transferred anywhere from 3-5 days later.

During an IVF cycle there can be several stages where one expects to experience pain. The first part where one anticipate pain is as the women starts her injections for development of eggs. … The third phase where woman expects pain is during the procedure of the egg retrieval itself.

  1. A needle is passed through the top of the vagina under ultrasound guidance to get to the ovary and follicles.
  2. The fluid in the follicles is aspirated through the needle and the eggs detach from the follicle wall and are sucked out of the ovary .

Some couples would benefit from doing IVF sooner rather than having more tests, more surgery and more IUI cycles that are relatively low yield for getting the baby they want. The big advantage of in vitro fertilization is that it has a much higher success rate than any other infertility treatment.

This is one of the most asked questions when seeking infertility treatment. ICSI and IVF are both assisted reproductive techniques that require medical intervention from a fertility expert. The two procedures almost have a similar procedure except during the fertilization step in ICSI where a single sperm is injected into the egg for fertilization to occur.

Generally, most people hardly know about ICSI treatment mostly because IVF is more advertised than any other technique of fertilization. The Intracytoplasmic Sperm Injection (ICSI) is perceived to be more technical by some fertility experts than IVF treatment.

  • Ovarian Stimulation

This is also applicable to IVF a process where fertility drugs are provided or administered in a woman to bring about follicular development in the ovaries.

  • Egg retrieval

The matured eggs will be removed through a minimally invasive procedure. A woman may experience cramping and stopping after the procedure.

  • Sperm retrieval

The sperm must be obtained from a man through masturbation or may be surgically extracted. The sperm will be washed and prepared in the laboratory.

  • The best sperm is trapped or selected by a sharp tool in the form of a needle. It is then inserted into the ‘Zona’ of the egg down to the cytoplasm (the core of the egg)
  • Once the sperm is successfully administered into the cytoplasm, the needle is removed. The egg or eggs will be monitored for a few days to watch as they are being fertilized or not
  • The best embryo will then be selected for embryo transfer to cause successful implantation and conception

The average success rate of ICSI is 42%, but the success rate of ICSI Treatment in India basically depends on the age of a woman and the quality eggs.

When compared to IVF, the success rate of the two procedures is 3 to 7 (ICSI to IVF) and that makes a huge difference between the procedures.

Donor sperm can also be used in ICSI treatment.

This is known as an embryo manipulation technique aimed at causing fast implantation by creating a gap in the Zona pellucida. The procedure used a beam of laser energy that hit the hard shell of the egg two or multiple times to create the gap.

Contact with the egg is strictly limited to prevent damaging the egg and rendering the procedure a failure.

The procedure is expensive and obviously, increases a single ICSI cost in India.

After laser assisted hatching, the embryo will then be transferred back into the uterus.

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