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For normal male fertility:

• Sperms have to be carried into the semen.
• There needs to be enough sperm in the semen.
• Sperm must be functional and able to move
Medical causes:
• Varicocele
• Infections
• Ejaculation issues
• Antibodies that attack sperm
• Tumors
• Undescended testicles
• Hormone imbalances
• Defects of tubules that transport sperm
• Chromosome defects
• Problems with sexual intercourse
• Celiac disease
• Certain medications
• Prior surgeries
Environmental causes
• Industrial chemicals.
• Heavy metal exposure.
• Radiation or X-rays.
• Overheating the testicles.
Health, lifestyle and other causes
• Illicit drug use.
• Alcohol use.
• Tobacco smoking.
• Emotional stress.
• Weight.

Yes, it can be treated in most cases.
In some cases, the doctor will recommend that the couple seek assistance of assisted reproductive technologies (ART), such as IVF (in vitro fertilisation). ART does not cure or treat the cause of infertility but they can help couples achieve a pregnancy, even if the man’s sperm count is very low.

World Health Organization (WHO) has recommended the following as guidelines for normal Semen Parameters

Parameter WHO 2010
Volume 1.5 ml
Concentration 15 million/ml
Progressive motility 32%
Normal forms 4%

There are chances it may become normal after treatment. It depends upon the cause of male infertility. Severe cases may not become normal after treatment.

1) Increased intake of fruits and vegetables.
2) Increased intake of more lentils and spinach
3) Avoid saturated fat containing diet like

  • Processed foods
  • Meat
  • Dairy products like cheese


The most common causes of female infertility:
Ovulation problems may be caused by one or more of the following:
• A hormone imbalance
• A tumor or cyst
• Eating disorders such as anorexia or bulimia
• Alcohol or drug use
• Thyroid gland problems
• Excess weight
• Stress
• Intense exercise that causes a significant loss of body fat
• Extremely brief menstrual cycles
Damage to the Fallopian tubes or uterus can be caused by
• Pelvic inflammatory disease
• A previous infection
• Polyps in the uterus
• Endometriosis or fibroids
• Scar tissue or adhesion’s
• Chronic medical illness
• A previous ectopic (tubal) pregnancy
• A birth defect
DES syndrome
The medication DES, given to women to prevent miscarriage or premature birth can result in fertility problems for their children.

Abnormal cervical mucus can also cause infertility. Abnormal cervical mucus can prevent the sperm from reaching the egg or make it more difficult for the sperm to penetrate the egg.
Polycystic Ovary Syndrome (PCOS): It is a condition caused by imbalanced hormones in the reproductive system of females resulting in the decrease in the egg production and thus reduces the chance of getting pregnant.
Unexplained reasons: An unexpected infertility is when the causes are not clearly defined or identifiable that happens in 20% of the infertility cases. More advanced methods of female infertility treatment are required to diagnose and analyse such other cases like this.
Epileptic: According to research conducted, reproductive abnormalities and infertility are two or three times more common in Epileptic females. This is because epileptic seizures can lead to an increase in the serum prolactin level and fluctuation in women’s reproductive hormones.

Female infertility is most often treated by one or more of the following methods:
• Taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle
• Taking medications to stimulate ovulation
• Using supplements to enhance fertility – shop supplements
• Taking antibiotics to remove an infection
• Having minor surgery to remove blockage or scar tissues from the Fallopian tubes, uterus, or pelvic area.
Medical Therapy: Special drugs can be given to women facing problems with ovulation. Gonadotropins are also used in case of unexplained infertility.
Assisted Reproductive Technology or ART: It is one of the best-known treatment options available. This technology is performed through the combination of fertility drugs and hormonal therapy. Other types of tests include gamete intra- fallopian transfer, In Vitro fertilization, intrauterine insemination, and zygote intrafallopian transfer.
Intrauterine Insemination: It is another procedure which uses a small amount of concentred sperm cells. This is a painless process and takes few minutes to accomplish.
In Vito Fertilization: It is a comprehensive and highly advanced procedure in order to assist the sperm and the egg. IVF is a technique of artificial insemination in which the egg and sperm are combined outside the body and then placed in the uterus after the formation of the embryo. The drug called Clomiphene or Clomid and Serophene are highly recommended treatments for infertility problems.
Egg Donation: Egg donation involves the removal of Oocytes from the ovary of a woman who has taken fertility drugs for ovarian stimulation.
Surrogacy: In surrogacy, the surrogate mother is inseminated with the sperm from the recipient’s partner. The surrogate mother then carries the baby and delivers it on the behalf of the recipient.

It certainly suggests that there remains a reasonable chance of spontaneous pregnancy after fertility treatment has been attempted.
In one study, the authors found that 87 per cent of the spontaneous conceptions occurred within two years of finishing the infertility treatments.

Couple will be investigated and the treatment plan will be made accordingly. Not all patients with fertility issues require IVF.

12% chance per month of conceiving IUI insemination for up to 3 cycles (much lower for more than 3 attempts)
55% chance for having a baby after one cycle (month) of IVF treatment – pregnancy success rates vary greatly between IVF clinics.

III) Poly cystic ovarian syndrome

• Researchers and health care providers know that genetic and environmental factors contribute to the development of PCOS,
• the syndrome is probably caused, at least in part, by a change, or mutation, in one or more genes.
• Recent research conducted in animal models suggests that in some cases PCOS may be caused by genetic or chemical changes that occur in the womb
• PCOS likely results from a combination of causes, including genes and environmental factors.
• Most of the symptoms of PCOS are caused by higher-than-normal levels of certain hormones, called androgen.
• The ovaries produce hormones, which are chemicals that control functions in the body.
• One of the hormones that the ovaries make is estrogen—sometimes called the “female hormone” because woman’s bodies make more of it than men’s bodies do
• The ovaries also make androgen’s—sometimes called “male hormones” because men’s bodies make more of them than woman’s bodies do.
• Interfere with signals from the brain that normally result in ovulation, so that ovulation does not occur regularly
• Cause the follicles—small, fluid-filled cysts within the ovaries in which eggs grow and mature —to enlarge, forming cysts
• Produce other symptoms of PCOS, including excess hair growth and acne.

• With PCOS, LH levels are often high when the menstrual cycle starts. The levels of LH are also higher than FSH levels.
• Because the LH levels are already quite high, there is no LH surge. Without this LH surge, ovulation does not occur, and periods are irregular.
• Girls with PCOS may ovulate occasionally or not at all, so periods may be too close together, or more commonly too far apart. Some girls may not get a period at all.

Yes it can be managed once it is diagnosed, based on sonological and hormonal parameters

Yes….Following diet chart can help….
PCOS Diet Tip 1: Stop deprivation dieting.
The real definition of “diet” means nourishment or nutrition. This implies health and wellness—not starvation. healthy eating can and should be enjoyable.
Include more natural foods like lentils, vegetables, and local, organic ingredients into your daily meals.
To make these healthy PCOS diet changes, cut out white breads, pasta, potatoes, cereals, and some fruits and snack foods. Replace those items with healthy PCOS diet options like the following:
• Nutrient dense, high-fiber carbs
• Foods high in protein (lean meats, legumes)
• Foods containing healthy fats (olive oil, nuts, fish)

PCOS Diet Tip 2: Physical Exercise and Workouts
• Regulates blood glucose levels
• Offers a mood boost
• Increases endorphins (the body’s natural opioids)
• Gets us in top physical shape for pregnancy
• Increases weight loss.

There is no cure yet, but there are many ways you can decrease or eliminate PCOS symptoms and feel better. There are medicines that can treat symptoms such as irregular periods, acne, excess hair, and elevated blood sugar. Fertility treatments are available to help women get pregnant. Losing as little as 5% excess weight can help women ovulate more regularly and lessen other PCOS symptoms. The ideal way to do this is through nutrition and exercise.
The biggest health concerns are diabetes, heart disease, and stroke because PCOS is linked to having high blood pressure, pre-diabetes, and high cholesterol.

IV) TSH and Infertility

Symptoms of Hypothyroidism may be vague and can often mimic other conditions. They may include:
• Changes in the menstrual cycle
• Constipation
• Depression
• Dry hair and hair loss
• Dry skin
• Fatigue
• Greater sensitivity to cold
• Slow heart rate
• Swelling of the thyroid gland (goiter)
• Unexplained weight gain or difficulty losing weight
• Carpal tunnel syndrome
Symptoms of Hyperthyroidism: Visibly, the thyroid gland itself can swell into a goiter, which can be either symmetrical or one-sided. Your eyes may also appear quite prominent, which is a sign of exophthalmos, a condition that’s related to Graves’ disease.
Other symptoms of hyperthyroidism include:
• increased appetite
• nervousness
• restlessness
• inability to concentrate
• weakness
• irregular heartbeat
• difficulty sleeping
• fine, brittle hair
• itching
• hair loss
• nausea and vomiting
• breast development in men

V) Success rates in IUI and IVF

• Average Success rates in IUI 15-20% across the world. At GarbhaGudi, the success rates for IUI is between 25% and 32%
• Average Success rates in IVF 40-50%. At GarbhaGudi, the success rates for IVF is between 55% and 60%

• Proper patient selection.
• Establishing tubal patency before IUI.
• Gonadotrophin stimulation.
• Ensuring good semen processing technique.
• To correct underlying defects like thyroid disorders, PCOS treatment.
• Weight reduction in obese patients.

3-4 cycles usually. Some couples may be asked to move to IVF much before that too, if there are severe male issues or of the age of the female is above 35.

Yes. Typical child bearing age is accepted to be between 22 and 28 years. As the age of the lady increases, the chances of pregnancy drop. It drops quickly after the age of 35 and the drop is significant after 40 years.

VI ) Birth anomalies in IVF

• The major birth defects seen in babies born via IVF and/or ICSI included heart defects and malformations of the urogenital tract, such as hypospadias.
• genetic disorders
• Children born via assisted reproductive technology had a five times higher rate for minor birth defects such as angiomas
• It is not fully understood whether these birth defects or genetic diseases are caused by the infertility treatment itself or the underlying reason for infertility.

• In their study, scientists at the University of California, Los Angeles (UCLA) looked at birth defects among infants born both via IVF and conceived through natural means in California, which has the country’s highest rate of IVF use. They included babies born after IVF and other assisted reproductive treatments such as couples’ use of fertility-enhancing drugs and artificial insemination.
• Among 4795 babies born after IVF and 46,025 infants who were conceived naturally, 3,463 babies had congenital birth defects. Even after controlling for factors that can affect such birth defects, such as mother’s age, and race, which can influence rates of genetic and environmentally driven developmental disorders, 9% of infants born after IVF had birth defects compared to 6.6% of babies who were conceived naturally. Overall, the babies born after IVF were 1.25 times more likely to be born with abnormalities. The researchers did not find a link between birth defects and other fertility treatments like artificial insemination or ovulation induction.
• It’s possible that the higher rate of abnormalities with IVF is due in part to whatever was contributing to infertility in the first place, say the researchers. But the fact that an increase was not seen among babies conceived using artificial insemination or ovulation induction suggests that process of IVF itself, in which eggs are removed from a woman, fertilized in a dish with sperm and then allowed to develop into embryos, which are transplanted back into the womb, is the primary culprit.

Preimplantation Genetic Screening (PGS) for aneuploidy is a powerful genetic test that may be performed on embryos during IVF treatment to screen for numerical chromosomal abnormalities. PGS is performed on a small embryo biopsy prior to transfer and identifies which embryos are chromosomally normal. Chromosomally normal embryos are the most likely to develop to term and to be born healthy. PGS testing helps IVF physicians and patients decide which embryos to transfer.

Over 50% of spontaneous miscarriages are caused by chromosomal abnormalities. Some birth defects are caused by chromosome abnormalities, and the risks of having a child with a chromosome abnormality increases with maternal age. Couples who are at increased risk of having aneuploidy embryos should consider using PGS testing. These groups of individuals include:
• Women over 35 years of age
• Couples who have experienced several spontaneous miscarriages of unknown cause
• Couples with several cycles of IVF that have not achieved pregnancy
• Men with low sperm concentration
• Couples with a previous pregnancy with chromosomal abnormality
The selection of chromosomally normal embryos in these couples greatly reduces the risk of miscarriage and increases reproductive success.

VII) Twin anomalies in IVF

Ironically, IVF – the very procedure that has played a part in the rise of multiple births – is playing an important new role in reducing them, thanks to innovative technology and techniques:
Blastocyst Culture and Transfer – Clinicians grow the embryos in a nutrient-rich media for five days instead of the conventional three. This enables them to select the healthiest, promising embryos for implantation. Fewer need to be implanted, and the remainder can be frozen for future use, if needed.
Elective Single Embryo Transfer (eSET) – Studies show that implanting multiple embryos in women under 35 doesn’t improve the pregnancy rate, it just increases the chance of a multiple birth. With eSET, a single embryo, usually a blastocyst, is transferred. The American Society for Reproductive Medicine recommends a single embryo in women under 35 – two in those with an unfavorable prognosis.
Preimplantation Genetic Diagnosis (PGD) – Microscopic evaluation of early-stage (3-day) embryos identify those with the best development characteristics.
Comparative Genomic Hybridization (CGH) – This new screening technique examines the 5-day blastocyst, allowing analysis of all 23 pairs of chromosomes to identify abnormalities thought to be responsible for implantation failure.

The goal of all fertility treatments should be the birth of a healthy baby with as few risks to the mother as possible. To do this when undergoing in vitro fertilization (IVF), we can plan a single embryo transfer (SET). This means transferring one embryo into the uterus, in order to prevent multiple births.culprit.

Type of anomaly
Anomalies associated with twinning
• conjoined twins
• TRAP sequence (acardiac twins)
Chromosomal anomalies
• trisomy 21
• trisomy 18
Central nervous system
• neural tube defects
• isolated VSD
Genito-urinary system
• renal dysplasia
• Hydronephrosis
• Musculoskeletal system

The average prevalence of a birth defect was 5.7% among naturally conceived births, 7.1% for the IVF births, and 9.9% for the ICSI births, across all age groups.

VIII) Side effects in IUI and IVF

As with most medical procedures, there are potential risks. Fertility medications can have various side effects including headaches, mood swings, abdominal pain, hot flashes, and bloating, amongst other side effects. Although it is rare, fertility medications may cause ovarian hyper-stimulation syndrome (OHSS).

Some side effects after IVF may include:
• Passing a small amount of fluid (may be clear or blood-tinged) after the procedure.
• Mild cramping.
• Mild bloating.
• Constipation.
• Breast tenderness.

side effects of IUI
• Hot flashes.
• Mood swings and depression.
• Nausea, headaches or visual disturbances.
• Swollen and painful ovaries, signaling ovarian hyperstimulation syndrome (OHSS)
• Pelvic discomfort, breast tenderness, or bloating.
• Ovarian cysts.

Ovarian hyperstimulation syndrome (OHSS) is a medical condition affecting the ovaries of some women who take fertility medication to stimulate egg growth. Most cases are mild, but rarely the condition is severe and can lead to serious illness or death.
Classification of OHSS
• OHSS is divided into the categories mild, moderate, severe, and critical.
• In mild forms of OHSS the ovaries are enlarged (5–12 cm)
• In moderate form there may be additional accumulation of ascites with mild abdominal distension, abdominal pain,[2] nausea,[2] and diarrhea.
• In severe forms of OHSS there may be hemoconcentration, thrombosis, distension, oliguria (decreased urine production), pleural effusion, and respiratory distress. Early OHSS develops before pregnancy testing and late OHSS is seen in early pregnancy. Criteria for severe OHSS include enlarged ovary, ascites, hematocrit > 45%, WBC > 15,000, oliguria, creatinine 1.0-1.5 mg/dl, creatinine clearance > 50 ml/min, liver dysfunction, and anasarca.
• Critical OHSS includes enlarged ovary, tense ascites with hydrothorax and pericardial effusion, hematocrit > 55%, WBC > 25,000, oligoanuria, creatinine > 1.6 mg/dl, creatinine clearance < 50 ml/min, renal failure, thromboembolic phenomena, and ARDS.


Embryo biopsy is the removal of one or just a few cells from the embryo (depending on the stage of development). If the embryo is handled correctly by a skillful embryologist, the embryo develops normally after embryo biopsy. Published studies demonstrate that there is no increased rate of birth defects in IVF babies that are born after biopsy compared to IVF babies that are born without embryo biopsy.

Igenomix can perform PGS testing on embryos that are biopsied at either day 3 or day 5. A 3-day-old embryo has approximately 8 cells, and so only a single cell is removed for a biopsy done at day 3. A 5-day-old embryo has a few hundred cells, and so several cells can be safely removed during the biopsy. There are several good reasons to do either a day-3 or a day-5 biopsy. The number of cells that can be safely removed, rates of mosaicism, expertise of the embryologist, and embryo quality are all important factors in deciding when to do embryo biopsy. Patients should discuss with their IVF doctor the best time to do the biopsy. (Mir et al., 2016).

No genetic test can detect all potential genetic abnormalities. PGS testing for aneuploidy can only assess numerical changes in chromosome number and other imbalances in genetic material including deletions and duplications. PGS will identify any missing or extra chromosomes, deletions, duplications, and unbalanced rearrangements that are larger than our detection limit of 6 Mb. PGS for aneuploidy screening cannot rule out single gene disorders, balanced structural abnormalities, uniparental disomy, and genetic imbalances including deletions and duplications smaller than our detection limit of 6 Mb. PGS can detect some types of polyploidy but cannot detect polyploidy in which the sex chromosomes are found as a multiple of normal (triploidy 69,XXX and tetraploidy 92,XXXX or 92,XXYY).

When an embryo is identified as normal after PGS testing, the likelihood of a pregnancy is higher than 60% in women younger than 40 years. In women over 40 years, there is a higher percentage of cycles in which all embryos are abnormal, but when normal embryos are found, the likelihood of pregnancy is about 50%.

The likelihood that embryos will be chromosomally normal decreases as women get older. According to data generated at Igenomix, the average percentages of normal embryos are:

Maternal Age (years) %Normal Embryos
30-34 60%
35-39 40%
40+ 20%

These estimates are based off of a large data set from many combined PGS cases and may not apply to small numbers of embryos from a single PGS case. Igenomix cannot guarantee that there will be normal embryos for any PGS test.

Although PGS for aneuploidy screening is highly accurate, there is still a chance of misdiagnosis. PGS cannot detect mosaicism in the embryo because only a single cell or just a few cells are analyzed. Prenatal testing is recommended to confirm the results of PGS testing and may detect other abnormalities not tested for by PGS. Pregnant mothers should discuss options for prenatal testing with their obstetrician. Non invasive prenatal testing could be also an alternative.