Tuesday, 29 April 2014

What Causes Unexplained Infertility in Men?


About 30 per cent of couples are diagnosed with unexplained infertility without plausible answers. However, few defined reasons behind infertility apart from low sperm count, poor sperm motility in the man to blocked fallopian tubes or endometriosis in the woman include – DNA Damage in individual sperm.

Millions of couples seeking fertility treatment hop towards India with a hope of low-cost and transparent treatment. When they come to know about “unexplained infertility”, it becomes difficult for them to come in terms with the reality. 

At Pahlajani IVF Clinic, we first establish the causes for infertility before appropriate course of assisted conception treatment.

When males are diagnosed with damaged DNA in sperm, the couples starts panicking and invests a lot of time and money in fertility treatments, such as intrauterine insemination (IUI). However, it is suggested that to first find the possible cause for unexplained infertility in men and later find suitable fertility treatments. This can increase their chances of having a baby.

Also, the chances of having a baby in vitro fertilization (IVF) is closely related to the amount of DNA damage a man has in each of his sperm. A little damage is normal in the sperm of men who are fertile. 

But if there is high sperm DNA damage (more than 25% of damage per sperm), then the couples’ chances of getting pregnant are reduced – even with some forms of fertility treatments.

Doctors carry out a unique test for male infertility that measures damaged DNA in individual sperm. This test provides the couple with specific information about the causes and extent of their infertility. It can also predict the success of infertility treatments leading to reduced waiting times and improved chances of success.

Sometimes, the answers provided by fertility doctors are not satisfying, which therefore leaves the couple in dilemma about the whole process. In such a situation, a couple should remember that fertility doctors and reproductive endocrinologists are likely to make mistakes. Not always, but few fertility specialists miss out something that another could catch right away. 

It is better to be informed about the procedure and keep your queries before doctors without reticence. It will be better for both doctor and the couple. If you’re not satisfied with your doctor’s opinion or diagnosis of unexplained infertility, you need to get a second opinion.

Dr Neeraj Pahlajani

Monday, 28 April 2014

Understanding the Results of Semen Analysis - Sperm Structure and Motility


Male infertility contributes about 33 % in failure of conceiving. If you are trying to have babies but the attempts were left futile, then one of the important tests that men should undergo is Semen Analysis Test. The test would determine the man’s sperm count, motility and production, which are important for pregnancy.

Anatomy of sperm divides it into three sections:  

  • Head
  • Midpiece
  • Tail


For a sperm to be considered normal, all the three above sections should be have specific structure for motility. A little description would help you understand about these three sections and what actually is determined in sperm test.

What is a Sperm Made of?

Under the microscope, the trisection of sperm is observed more closely,

Head, having larger surface area than the other two sections stores all the genetic material. Now, if the sperm has an abnormal head, it is incapable of fertilizing an egg.

Midpiece, an area between head and tail of a sperm contains fructose, which gives the sperm required energy to gain speed and move faster.

Finally, the tail for forward motion and it gives thrust to the sperm. So, a sperm with no tail, two tails, or coiled tails are abnormal, and won’t help with getting pregnant.

What Does Your Semen Analysis Mean?

Once you are handed over the report of your sperm test, you see the terminologies, sperm volume, concentration, motility, or morphology. Don’t get confused! These terminologies would be reliable source of information if you know,
  1. Normal sperm volume (amount) – Between 1.5 and 5 ml.
  2. Normal sperm concentration – greater than 20 million sperm/ml or a total of greater than 40 million per ejaculate.
  3. Normal sperm motility - more than 40% of the sperm should be moving.
  4. Normal sperm morphology - more than about 30% of sperm should be normally shaped.
  5. Normal sperm forward progression - at least 2, on a scale of 1 to 4.
  6. Sperm white blood cells - no more than 0 to 5 per high-power field.
  7. Sperm hyperviscosity - the semen should gel promptly, but should liquefy within 30 minutes after the sample is taken.
  8. Sperm pH - alkaline, to protect sperm from the acidic environment of the woman’s vagina.

Special instructions to collect sperm for a semen analysis

Before undergoing the test, men should,

  • Abstain from sexual intercourse for 2-3 days before providing semen for analysis;
  • Generally, the sample is frequently collected by masturbation. But, sometimes the technicians might also collect it after sexual intercourse, using a special condom that lacks spermicidal agents that are detrimental to sperm.
  • The sample may be collected at home or in an appropriate laboratory.
  • Men undergoing the test should ensure that the sample is kept at room or body temperature and is tested within an hour of collection.

Remember, your sperm test results may vary with unusual sperm count, motility, or production, if you were not well, going through routine medications or ill, taking medication.

Dr Neeraj Pahlajani

Sunday, 27 April 2014

The Best Time for Getting Pregnant - 3 Signs of Fertility


Pregnancy is never sudden rather it depends on the pattern of ovulation. Predicting ovulation would help you identify the best time of the month to conceive a baby. Before going for those predictor kits, here are few things that you must know about ovulation.

Women’s menstrual cycle is divided into three phases:
  • Pre-ovulatory infertile phase
  • Fertile phase, and
  • Post-ovulatory infertile phase

By observing the primary fertility signs, women can determine which of the three phases they are in. The three primary fertility signs are:

Waking temperature

If your waking body temperature rises between 97.6 to 98.6 degrees Fahrenheit, you are surely ovulating. And if it between 97.0 and 97.5 Fahrenheit, you are not ovulating.

Understanding the highs and lows of your body temperature would help you to know if ovulation has occurred. The considerable rise in waking temperature indicates the occurrence of ovulation. However, unlike the other two signs (cervical fluid and cervical position), waking body temperature does not reveal impending ovulation.

Cervical fluid  

This is the sign of impending ovulation. Body produces cervical fluid before you ovulate. Fluid acts as filtering mechanism to nourish the sperm. It creates an alkaline environment and encourages the sperm to reach the egg.

With the approach of ovulation, the in female body estrogen rises and the cervical fluid becomes more evident. It is first a little sticky, and then a creamy discharge. The final phase of cervical fluid is a clear, slippery, stretchy substance (similar to raw egg white). This is a sign of fertility — and recognizing these signs quickly can help you conceive.

Cervical position

Women find it difficult to spot this sign of ovulation, as it is hardest to predict and needs practice finding the cervical positions that indicate optimal fertility. Every month, women’s cervix prepares for pregnancy by becoming soft and “mushy”, rising a little higher, and opening up. The increase in estrogen secretion causes the cervix to change angle as well, and to emit fertile cervical fluid.

Women need to start observing the minor changes in their bodies to predict cervical position. Slowly, in each cycle you will be able to determine when your body is fertile and ready for pregnancy.

Watching the natural symptoms of ovulations during the phases of your menstrual cycle, would help you knowing the most fertile time to get pregnant. It is not that you cannot get pregnant during other times, but the knowledge of above three signs would increase your chances getting pregnant when you really want to. Do not forget that eating habits affects female fertility. So, eat healthy and add more nutrients to your diet.

Dr Neeraj Pahlajani


Friday, 25 April 2014

Reasons In Vitro Fertilization (IVF) Fails to Result in Pregnancy


The bitter truth behind a botched IVF cycle is – as advanced as fertility treatments are, the question about failure might not always have an answer!

When the embryos looked perfect, uterine lining looked great, and everything went according to prescription, then it is difficult accept the failure of IVF cycle.

Below are the reasons why sometimes In Vitro Fertilization doesn't work –

The embryos didn't implant

When the development of embryos stops prior to reaching implantation stage then uterine lining may possibly reject the embryo and the implantation fails. Women, in their mid 30s, who undergo IVF after detection of infertility, are more likely to encounter this situation. However, the cessation of embryo development is thought to be the most common cause of lack of pregnancy at any age, and in fact, even during natural conception. A woman’s age affects her chances of getting pregnant, whether or not infertility treatments are involved.

The embryos started to implant…and then stopped

If the embryos have abnormal chromosomes, they won’t implant. The only way to tell whether embryos have the right chromosomes is to do Pre-implantation Genetic Diagnosis (PGD), a procedure in which one cell is removed from the embryo before implantation and its DNA is analyzed for abnormalities.
Although this is an expensive medical procedure, it only checks the abnormalities and does improve overall pregnancy rates.

The embryos were damaged, so the IVF didn't work

The damage, either during the embryos’ growth in the lab or the transfer to the uterus might result in implantation failure. Like I have always said, the IVF is performed part by doctors and part by human body. From simulation to egg formation, retrieval to embryo formation, embryo transfer to implantation, IVF is requires both the efforts of doctor and response of the female’s body to the effort. Occasionally, the embryo does not grow as intended, which might damage the embryo.  

There is a problem with your uterus

If the uterine lining is not healthy or ready for the implantation, then there are chances your IVF would not work. Fibroids, polyps, or polycystic ovarian syndrome can make getting pregnant more difficult. Sadly, there are no ways to test the endometrium or uterine lining during the actual cycle because a biopsy might prevent implantation.

The embryo transfer process went poorly

If a woman experiences bleeding or cramping (or both) during the in vitro fertilization procedure, the chances of getting pregnant are considerably decreased. The uterus cramps, the embryos are displaced and become less capable to be implanted, as a result the IVF cycle fails.

Sometimes, patients blame the doctors. It is understandable because one might not want to expense of money and time without results. But, even though the infertility treatment is one of the most advanced medical procedures but sadly there are arenas which are yet to be discovered, like the prevention of implantation failure. You need to be positive and have faith on your doctor.

Dr Neeraj Pahlajani



When You Need to Find a Fertility Doctor


To know when exactly you need to go to a fertility doctor when you haven’t been getting pregnant could be difficult, partly because it is expensive and more importantly it feels like it means you have lost hope for a natural pregnancy and more.

The problem becomes more complex when you decide on visiting a gynecologist, who unfortunately does not specialize in infertility or works closely with an urologist, the you might be subjected to a series of futile tests that may deplete you finances before you even think about visiting a fertility specialist (who again might prescribe a number of tests) as your next preference.

How to Know You Need to Find a Fertility Doctor

If you are trying hard but it taking too long to get pregnant – whether it is six months or even two years – you need to actually start thinking about reasons.

Sometimes, women fail to reckon that male infertility might be the contributing factor. Male infertility equally contributes to problems getting pregnant just as often as female infertility does.

So, if you encounter problems in getting pregnant, then it is time you visit a fertility specialist, who would guide you through the right path to get out of the maze.

Signs it’s time to see a fertility specialist for both men and women

  1. You've been trying to get pregnant for over a year without success – This is the commonest and most obvious sign you need to find a fertility specialist. When you are under 35 years of age and have been trying to conceive for 12 months. Or, you’re over age 35 and you’ve been trying to conceive for more than 6 months. This is because, a woman’s chances of getting pregnant decrease as she ages — no matter how healthy, fit, and active she is! And, male sperm health decreases as he ages, too.
  2. You or your partner has chronic or past health problems – Diabetes, high blood pressure, or a history of cancer, are few examples that might affect the functionality of you ovary or testicles, putting your ovarian response or sperm production to back seat. 
  3. You've been seeing a family doctor for six months – If the pregnancy seems far-fledged after months of struggle even when you are consulting a family doctor for the same, then you need to see a fertility specialist, because sometimes family doctors are not the best infertility evaluators. Do not feel like you are betraying your family doctor! You can ask him for referral to a fertility doctor instead.
  4. You have irregular periods - If you have pelvic pain, heavy periods, and/or bowel or bladder symptoms around your menstrual cycle and the physician does not suggest having a hysterosalpingogram or laparoscopy to determine the cause, then you should see an infertility doctor.

Going to a fertility clinic may help you feel more in control of your journey towards getting pregnant – especially if you know what to look for when finding a fertility doctor.

Dr Neeraj Pahlajani

Wednesday, 23 April 2014

Signs of Fertility Problems in Women


Women in their busy routines, sometimes ignore the small problems faced repeatedly during the menstrual cycle. However, at some point of time they actually start thinking if they will be able to conceive a baby. But how do you know if you have fertility issues? 

Here are few common signs of infertility to raise an alarm before it is too late,   

The first and most obvious sign of a fertility problem is the lack of ability to get pregnant. Unless you want to actually get pregnant, you would not be able to encounter the problem. Birth control pills or condoms might keep you away from knowing these problems. 

So, all you need to do is try getting pregnant for few months. If you fail in the process try consulting a fertility specialist. 

Signs of Possible Fertility Problems for Women

Irregular periods (or no periods at all)

If you do not get your periods between regular intervals - or if you don’t get periods at all – then you may have fertility issues.

Sometimes, because of hormonal imbalance women get irregular periods and develop polycystic ovaries. It is not uncommon, about 10% of women are affected by this common health condition, which causes very small (less than 1 cm) cysts on the ovaries. Now, development of cyst might affect your fertility.

Pain during period

Fibroids, yeast or other infections, pelvic inflammatory diseases, and endometriosis can cause pain during menstruation. Is this a sign of fertility problems? Again, it depends on the reason for the pain. Some women have fibroids that don’t cause painful menstrual cramps. However, sometimes it becomes important to get them removed before in vitro fertilization.

If you experience painful cramps or abdominal pain during your period, go see a gynecologist. A minor fertility issue can grow into a serious problem if it’s not taken care of.

Painful sex

Although, not every time painful sex might lead to fertility problems but it depends on the reason of pain. One of the major reasons could be, Endometriosis - it can be problematic if you want to get pregnant. To know more about Endometriosis visit – www.raipurivf.com

The first thing you can do when you have acute pain during intercourse is to consult your family doctor or gynecologist. Determining the actual cause of pain would allow you to discover if there is a threat to your fertility or not, because not always painful sex means infertility.

Sexually transmitted diseases

If you have STDs or sexually transmitted diseases, you might experience pelvic inflammatory disease, which is an infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. 

The most of symptoms of Pelvic Inflammatory Disease (PID) is lower abdominal pain.
STDs such as gonorrhea or chlamydia can cause fertility problems in women and men. 

In women, the problem comes from scar tissue buildup that affects your ability to get pregnant.

Common Reasons Women Can’t Get Pregnant

  • Age – women lose fertility after age 30, more after 35, and faces acute problems in conceiving after age 40.
  • Underweight or overweight – women with Body Mass Indexes (BMIs) over 30 and under 20 have better chances of getting pregnant. Ideal BMI is between 20 and 30.
  • Hormonal changes – can cause fertility problems.
  • Endometriosis or fibroids – can make getting pregnant difficult, depending on how advanced the disease is.
  • Miscarriages – the more miscarriages a woman has, the less likely she may be to get pregnant.
  • Sexually transmitted diseases – can affect a woman’s reproductive system.
  • Pelvic inflammatory disease – can cause problems with getting pregnant.

Dr Neeraj Pahlajani

Tuesday, 22 April 2014

Natural Cycle IVF - Procedure, Treatment and Benefits


Natural IVF cycle or gentle IVF is a simpler way of doing in vitro fertilization. It is beneficial for patients with poor ovarian reserve because they do not respond well to superovulation with gonadotropin injections. The process is done using minimal or sometimes no ovarian stimulation.

It is a preferred because of the following perspectives,

  • Fewer side effects
  • Less expensive
  • Good success rate
  • It can be repeated


However, the patients treated under this type of IVF should understand the challenges involved in the treatment. The procedure is quite demanding in terms of egg retrieval timing and fertilization of egg.

The process adapted at Pahlajani Infertility Clinic for natural IVF involves,

  1. We start with vaginal ultrasound scan on day 7 to estimate the follicular size and thickness of the endometrium and ensure the viable and growing follicle.
  2. After the confirmation, the patient is given Gonadotropin-releasing hormone (GnRH) (also known as Luteinizing-hormone-releasing hormone (LHRH)) antagonist medication to avoid untimely LH surge.
  3. Later, the scan and E2 blood test is performed on Day 10.
  4. We wait for the follicle size to grow about 18 mm and E2 (estradiol) level to reach 200pg/ml, and then give the HCG trigger shot.  In general, a 'good' estradiol level is between 150- 500 pg/ml on day eight of an IVF cycle. Approximate doubling of the day eight value every 48 hours is a positive sign of continued follicle development. 
  5. After 36 hours of the HCG shot, we collect the egg. 
  6. Embryologist fertilizes the egg and the formed embryo is transferred to the patient’s uterus within 48 hours.

Another treatment that we recommend at Pahlajani IVF Clinic is mini-IVF. It has better pregnancy rate and involves mild super ovulation to ensure the growth of 2-3 follicles. The treatment is similar for mini IVF as used in natural IVF with some additional medical treatment. 


In mini-IVF, the first scan is performed on Day 2 to absence of ovarian cysts and down regulation. The slight difference is that the patients are put through Letrozole from day 2 to day 6 and Menogon from day 3 onwards. The scan is performed on day 7 and rest of the procedure is similar as natural cycle.

Dr Neeraj Pahlajani