How many attempts should you try through IVF?

Conceiving a child proves to be difficult for more than 40 percent of males, and 40 percent of females, in fact 1 in 6 couples have difficulty becoming pregnant. If you suffer from infertility, you still have options available. In Vitro Fertilization (IVF) is one medical procedure that you can have to increase your chances of conceiving a child. This process allows you to use your eggs or sperm to conceive a child outside of the body. Once the eggs have been fertilized, the fertility specialists will insert a fertilized egg (now called an embryo) inside the uterus and wait to see if the procedure has been successful.

Most individuals that have the In Vitro Fertilization procedure will keep trying until they are successful. There is no guarantee that the procedure will work after the first or second cycle. In fact, the procedure may not work at all; however, 50 percent of individuals and couples who have IVF are successful. Some couples are lucky after the first cycle, but a large percent are not.

For this reason, you may need to keep on trying. The research suggests most couples will need approximately 6 embryo transfers before they achieve a pregnancy; because of the emotional, physical, and financial toll exacted by IVF, it is preferable that a couple undertake the process with the mindset that they will be in it for more than one attempt. If a couple can only afford one treatment cycle, IVF may not be the right course of action. Recall that on average, with conventional IVF, there is only about one chance in three that it will result in a live birth, and there is a tremendous letdown if it fails. It is thus unreasonable to undergo IVF with the attitude that “if it doesn’t work the first time, we’re giving up.” In vitro fertilization is a gamble even in the best of circumstances.

Statistically speaking, a woman under 40 years of age, using her own eggs, having selected a good IVF program is likely to have a better than 70% chance of having a baby within three completed attempts – provided that she has adequate ovarian reserve, (the ability to producing several follicles/eggs in response to gonadotropin stimulation), has a fertile male partner (or sperm donor sperm) with access to motile sperm, and has a normal and receptive uterus capable of developing an “adequate” uterine lining. Women of 39-43 years of age, who meet the same criteria, will likely have about half that chance (35%- 40%).

There are no limits to the number of IVF cycles you can have. This decision is entirely up to you and the fertility specialists. Of course you want to be healthy when you have the IVF cycles, or there is a higher chance of the cycle not being successful. Some couples have had more than 10 IVF cycles, while others have stopped after their first cycle; the decision is yours.  You can decide on the number of IVF cycles you have, but you need to be aware of the out of pocket costs associated with IVF. When the most “competent” embryos are selected for transfer using a new genetic process, known as comparative genomic hybridization (CGH), the birth rate per single, completed IVF cycle is likely to exceed 60% regardless of the age of the egg provider and, more than 85% within three such attempts.

Unfortunately, there will inevitably always be some women or couples who in spite of best effort at conventional IVF will unfortunately remain childless. In my considered opinion, it rarely advisable to undergo more than three IVF attempts using the same approach each time. There is of course one important caveat: in women where the reason for repeated IVF failure is finally uncovered, it would indeed be justifiable assuming there are sufficient emotional, physical and financial resources to continue trying, using a defined and new approach that addresses the reason for prior failures. Simply stated, “The time to stop trying is when there is no remediable explanation for repeated failure to achieve a viable pregnancy”.

When conventional IVF with or without egg donation and/or CGH embryo selection fails to yield a successful outcome, other options such as ovum donation, IVF surrogacy, or adoption should be considered. Although it is the right of any healthy women who has a uterus and is capable of producing even one follicle-egg to have the right to decide on doing IVF using her own eggs, given the very low success rate after 43 years of age (less than 10% per attempt and under 25% within 3 tries) it is our opinion that women over 43 years should be advised to rather do egg donor IVF. Here, regardless of the age of the embryo recipient, the IVF birth rate after a single attempt is about 60% and better than 80% within three IVF attempts.

Couples who choose to undergo IVF should be encouraged to view the entire procedure with guarded optimism, but nevertheless must be emotionally prepared to deal with the ever present possibility of failure. It is important for IVF patients to be made to realize from the outset that an inability to become pregnant should never be considered a reflection on them as individuals. There is no real age limit for women undergoing In Vitro Fertilization as long as the woman has not gone through menopause (in this instance donor eggs would need to be used). Many women in their 40s have the IVF procedure although positive results at this age are not very high. It has been reported that more than 10,000 cycles of IVF have been given to women who are over the age of 40. Out of those cycles, only 12 percent used donor eggs, but the other 88 percent used their own eggs for the IVF procedure. You have approximately a ten percent chance of having a baby through IVF if you are between the ages of 40 and 44.

How Infertility impacts emotional effect of couple relationship

Infertility is a medical problem that results in the inability to conceive a child or carry a pregnancy to full term. A couple is usually diagnosed as infertile after one year of frequent, unprotected, sexual intercourse. It is estimated that 10 to 15% of couples are infertile. About 35% of infertility cases can be traced to physical problems of the woman and 35% have causes in the man. In the remaining 30% of cases, infertility is either unexplained or is caused by problems in both partners.

The inability to have children can be one of the greatest challenges that a person or couple will ever face. It affects people emotionally, physically, and financially. It can place tremendous stress on a couple’s relationship and on their relationships with family and friends. On a physical level, the experience of being examined and tested monthly, weekly, or even daily is embarrassing, exhausting, and very expensive. Medications often have side effects, and daily injections may be required. Surgery is often necessary, and sometimes several procedures are needed.

As the process continues over months and years, the couple’s privacy is invaded time and again, physically and emotionally. One or both of the partners learn to put aside their feelings as they lie on the examining table, have fluids taken, or give sperm for the tenth, twentieth, or fiftieth time. At the same time, family, friends and coworkers are waiting to see if this month will bring good news. The couple becomes used to hearing, anything new? with an expectant smile. They also hear comments like, maybe you should take a month off and just relax or a vacation would do you good or these sounds like a good problem. At least you can have fun trying. To make it even worse, throughout this experience, the couple regularly hears of others who have become pregnant. In fact, it sometimes seems as if the whole world is pregnant.

These experiences often make the infertile person feel like a failure. The feelings come up each time there is a treatment failure or when yet another friend or acquaintance announces a pregnancy; after each expensive procedure or round of treatment, when no pregnancy results, the disappointment turns to devastation. Many infertile people become depressed and anxious. The strain in the marriage and among family members sometimes becomes unbearable. The self-esteem of one or both partners plummets. They often feel lonely, sad, and angry. The long series of disappointments that many experiences can cause a numbing effect and depression can result. If one partner has the medical problem that is causing the infertility, he or she often feels guilty and may even offer the other a divorce. At the same time, the infertile person may fear that the other partner will leave the relationship.

 All of these changes can make people feel emotionally distant and needing to avoid 1ntimacy. Some people cut themselves off from friends and family. They look for ways to avoid attending social gatherings and family events, fearing that they will be subjected to discussions about pregnancy, children, or infertility.  Socializing with friends and family who have children or who are pregnant is a special challenge. Sometimes these feelings are intensified, especially for women, when they are taking large doses of drugs that can affect their emotions.

Men and women are affected by infertility in different ways. Most couples experience the struggle in much the same way. This is related to the traditional ways men and women have been trained to think, feel and act. Women are typically seen, by others as well as themselves, as the emotional caretakers or providers of the relationship. Women typically feel responsible not only for everyone's bad feelings, but also for anything bad that happens. When women try to repress feelings, their emotions can become more ominous until they finally feel out of control. Their emotions can become a monster about to swallow them whole.

Women in infertile couples often protect their husbands from their own pain and feelings of failure by taking much of the responsibility for the treatments upon themselves. When it is suggested that men accompany their wives for appointments, couples get concerned about issues like income loss, use of time, etc. While these concerns are usually relevant and important, they also serve the purpose of protecting husbands from their own responsibility in the conception process and from their own feelings, which could easily be intensified by so much contact with the medical process.

Men are traditionally seen as the financial providers of the relationship and are responsible for protecting the family from real or imagined dangers. Men usually feel more threatened expressing themselves since they have often been conditioned to repress their emotions. They are trained to be more instructional to take charge, to make decisions and to think without being sidetracked by emotions.

Males in infertile couples often feel overwhelmed by the intensity of their partner's emotions as well as an inability to access their own. They tend to focus their energy back into their work, a place where they feel they can have more success.

As a result of taking responsibility for the emotional impact of the infertility, the woman experiences intense feelings, such as pain, anger, fear, etc., which, combined with the messages that her way of dealing with things is in some way dysfunctional or "crazy", causes her to feel an anxious depression. As feelings spill out, she feels out of control and doesn't really know how to ask for what she needs, especially from the husband she is struggling so hard to protect. She may yearn for an emotional connection/interaction at one moment and in the next withdraw emotionally from her husband when she fears she has disappointed him.

Men find themselves in a position where, regardless of how well they've been trained to solve problems, they are helpless to make this situation better for the woman and, as a result, may give off messages that she is "too" emotional or sensitive, hoping that this will calm her down. The wife hears this as criticism of her coping and care taking skills rather than as an expression of her husband's fears.

This is the time when couples cling together for dear life, feeling that they've failed in the most basic of all roles: reproduction. Couples are hesitant to admit problems in their marriage, feeling that having difficulty coping would mean that their marriage is also a failure.

Luckily, there are ways that men and women can help each other balance thinking and feeling as they struggle side by side on their journey toward parenthood. The questions then arise: How do I get what I need from my partner? How can I support for my partner during this difficult time?

Here are some suggestions to help both partners during the infertility process:

·         Communicate openly with each other.

·         Realize there's no right or wrong way to feel. Getting in touch with your feelings will help you know what you need. Once needs are identified, clearly and specifically tell your partner how to help you.

·         Ask your partner what she/he needs rather than assuming that you can/cannot give it.

·         Recognize the psychological and emotional differences between men and women.

·         See if you can teach each other some of the skills you've learned from your own life experiences as man or woman.

·         Share more in the process of treatment. Share both the burdens and joys of your different perceptions/experiences of infertility. It will help to balance the intensity and bring you closer with a deeper respect for each other.

Emotional Self-Care during Infertility treatment

Emotional Impact of Infertility almost no one expects to be infertile. Most people think they will grow up, get married, and have children, just like everyone else around them. So when a couple learns that they are infertile, they are often surprised at how devastated they feel.

 So why do they feel so badly? Most couples gradually come to realize that it is a distressing experience. Many eventually seek the help of a team of professionals, realizing that it is a good idea to create a support network and take advantage of the help that is available. When one or both partners start to feel the impact of infertility, it can be a good idea to seek the services of a mental health professional, especially one who understands the issues associated with infertility.

Since these issues are so complex, it is important to find a counselor who has experience and training in dealing with the impact on individuals, couples, and families. Many couples also find relief in support groups where they can meet regularly with other infertile couples, share experiences, and support each other.

 Infertility is primarily a medical problem, but during treatment it is important to address the emotional implications of infertility. Joining a support group or seeing a qualified counselor is especially important at any of the following points:

·         When you begin a new phase of your treatment.

·         After a course of treatment has failed.

·         When you are faced with difficult decisions about treatment.

·         When you are thinking about options such as surrogacy, egg or sperm .donation

·         When you are considering stopping medical treatment.

·         When you are thinking about adopting.

·         When one or both of you have troubling feelings that won’t go away.

·         When you experience strained relationships with your partner, friends or family.

·         When you avoid being with others because of the infertility.

Although a mental health professional cannot influence the outcome of the medical treatment, he or she can help the couple get through the process by helping them communicate better with each other and gain support from family and friends.

How do you strategies your unpredicted challenges when you preparing for IVF

Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event. While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique each patient will experience the stress differently based upon his or her own personality and life experiences.  Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, injections, sonograms, future health concerns, and decision making about embryos, their disposition and multiple pregnancies.

Unpredicted Challenges when you preparing for IVF

The aspects of IVF that are perceived as stressful by patients are multifaceted and affect all parts of their lives such as marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress may impact the marital relationship, by reducing sexual intimacy.  Couples also may find themselves stretched financially, paying for the high cost of IVF treatment with a somewhat limited probability of success. 

Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress like hot flashes, headaches, mood fluctuations, injections, sonograms, future health concerns, and decision making about embryos, their disposition and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third- party reproduction, if these values conflict with the choice of treatment.

The first treatment cycle has been found to be the most stressful for patients, with the possibility of high levels of confusion, bewilderment, and anxiety. This may be due in part to the fact that it is a new experience with an unfamiliar medical process, medications and treatment protocols that can change during the cycle, and possibly working with a new team of healthcare professionals. Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving on to the next phase of treatment as a monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation rises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization has occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process, and the uncertainty of the outcome is often highly distressing.

Managing Strategies during preparation and treatment of IVF

Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients adjust well emotionally. Further, there seems to be no long-term impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit. Those individuals who do develop uncomfortable anxiety or depression symptoms should consult with a mental health professional who has knowledge and experience with infertility.

IVF has the potential to be an emotionally, physically, and financially exhausting experience;  If you are a patient about to begin a cycle, here are some tips to help get ready for IVF:

v  Gather information and plan ahead - Good decision-making involves being well educated and informed about your body, the IVF process, and your clinic/treatment program. IVF is an anxiety-producing experience, and one of the best antidotes for anxiety is information and knowledge. The more you know and understand about the process, the less stress you may feel. Look for articles and other reading materials about IVF. Take advantage of resources from your treatment center, talk to others who have been through IVF, and consider seeking support from the list below.

v  Prepare for decision-making - It is important to anticipate decisions that may occur during IVF and discuss your options ahead of time. Sometimes these decisions may have moral and religious implications that you will need to consider and discuss. You will need to decide, along with your physician, how many embryos will be transferred while maximizing your chances for pregnancy and minimizing the possibility of multiple babies. You will also need to decide what you will do with extra eggs and/or embryos, i.e. freeze, dispose of, or donate them. If there is a possibility that donor gametes (sperm or egg) will be used in the cycle, it is important that you carefully discuss the issues involved in raising a donor-conceived child before starting the cycle. Counseling can assist you in exploring these issues and is recommended in the treatment guideline of the American Society for Reproductive Medicine.

v  Tend to your psyche and your relationships - A long struggle with infertility may have taken a toll on how you are feeling about yourself, your marital relationship, and/or your relationship with others, causing distress and isolation. You will want to be in a good place emotionally and have your relationship on solid ground before starting an IVF cycle. Facilitate communication with your partner by setting a limited amount of time to talk about IVF, such as 20 minutes a day, and then putting infertility talk aside. Discuss ahead of time your hopes and expectations of each other during the cycle. For example, whether you want to be together at appointments, on the day of the pregnancy test, and when you are expecting a call from the doctor. Counseling can be very helpful when you and/or your partner are feeling depressed, unusually anxious, emotionally stuck or in a rut. An ounce of prevention is worth a pound of cure, so get help early before problems arise.

v  Bring together your support - Friends and family can be your best support or they can be your worst. Decide in advance who you will tell about the procedure by identifying who will give you the support you need. In hindsight, patients often wish that they had not told so many people at the start, as it sometimes adds to the pressure. It can be helpful to designate a friend/family member as a "spokesperson" who will let others know, when you are ready, what is going on. In addition, look outside your usual support network to those who truly understand other infertility patients. If it is available in your medical practice, consider joining an IVF support group, or check out other infertility self-help organizations. The internet also is a ready source of infertility support and information, through various websites and chat rooms. A great deal of healing can come from others who understand.

v  Identify your stresses and your coping mechanisms - Each person experiences stress in different ways, so it is helpful to identify where yours may come from. For some, it may be in just getting to the clinic in the morning for monitoring, for others it may be injections. Anticipating ahead where your stresses may come from will help in developing coping strategies. Know your own and your partner's styles for dealing with stress and what has helped in the past. It is not unusual for each member of a couple to react differently to stress. For example, women may need to talk and receive support, while men may prefer to be involved in an activity or hobby to cope. Learning to accept differences in the way each of you handles and deals with your feelings can reduce conflict. In addition, exercise is one of the best ways to alleviate feelings of stress, anxiety and depression although the level of exercise may have to be adjusted during the treatment cycle. Humor is a great coping mechanism and can help you get through difficult times. No matter how tough things get, you can always find something funny about it and laughing about it is good for your health. Stress management classes, listening to relaxation tapes and other mind/body techniques used regularly can help in handling these feelings and dealing with treatment procedures. Of course, all of the above applies to single individuals undergoing IVF as well.

v  Decide what you have control over and what you don't- To help eliminate any unnecessary stress, you will want to make you life as simple as possible during the cycle. This is not a time to make important decisions or changes in your life, such as a move or job change. If at all possible, avoid major undertakings at work that can add stress to your life. In addition, you will want to think about how to deal with other daily life challenges on the job, at home, and with family and friends. You do have control over the choices you make in your daily life while how the treatment course progresses is usually out of your hands.

v  Anticipate problem areas - Plan for possible changes and difficult times during your cycle, such as the waiting period after transfer and the day you will get the results. Expect the unexpected, as changes are frequently made in the cycle because of everyone's unique medical situation. There are possibilities for failure at every step of the cycle, from a poor response to medication to no fertilization after retrieval. 

v  Waiting period - The 10-14 day waiting period between transfer and receiving the pregnancy test results is often described as the most difficult part of the cycle. Having had daily contact with your medical support staff during monitoring and retrieval, you suddenly are on your own after transfer and just have to wait. You need to think about how to fill your time during this time, and then consider where you will be when you receive the results (probably not at work) and whether you want to be together to hear the news. To allow some time to deal with what you learn, you may want to consider "fibbing" to family and friends by telling them the results are due a few days later than reality. This will give you breathing space and time to adjust to the news before dealing with others.

v  Look past this cycle at the beginning - It is important to be looking ahead as you prepare for IVF and to consider your limits as you begin the process. It is easy to know how you will feel if treatment is successful and you become pregnant. However, you must also understand that if you are unsuccessful in achieving a pregnancy, you cannot get away from the sadness, loss, and disappointment that are part of the grieving process. Think about the number of cycles you are willing or able to do, and how much more time and money will be involved in infertility treatment, knowing that you can always reassess later. Remember that with each cycle new information is learned that can help future decision-making. Consider exploring other family building options, such as adoption, which will give you some control and provide information for future choices. No matter what the outcome of IVF, you need to recognize you have succeeded in doing all that is within your power to have a child, and can feel good about yourself. Doing so minimizes any possible future regrets.

Getting Pregnant with Premature Ovarian Failure

The word menopause refers to the last menstrual bleed. Menopause is clinically defined as amenorrhoea of 12 months' duration after the final menstrual period. Menopause does not usually occur until a woman has reached her late forties or early fifties. Symptoms of menopause include hot flushes, night sweats, sleep disturbance, depression and mood disturbance, memory and attention deficits, vaginal dryness, frequent urinary tract and Joint pain. For most women the symptoms spontaneously resolve within a few years (1-2 years). However, about one third of postmenopausal women will experience symptoms for longer periods and in about 10% women the symptoms are severe enough to warrant medical help. There are certain long-term health issues. Resulting from estrogen deficiency, these health issues primarily consist of an increased risk of cardiovascular disease and osteoporosis, which increases the risk of bone fractures.

What is Premature Ovarian Failure (Premature menopause)?

The term premature menopause (premature ovarian failure) is defined as the occurrence of menopause before the age 45. Premature ovarian failure can present at varying ages and in many forms. If premature menopause happens before puberty, the woman will present with lack of sexual developments and her periods will not started. If the condition presents after puberty, the woman will suffer from amenorrhoea and infertility. The diagnosis of premature menopause can be a shattering experience to the women and her family.

Since the woman's estrogen production is low, hormone replacement treatment is prescribed to put the brakes on the premature ageing effects of menopause such as hot flushes, night sweats, vaginal dryness, low mood and depression and osteoporosis. 

Premature Ovarian Failure, Early Menopause and Pregnancy

Pahlajani Test Tube Baby Centre is a leading fertility center in India with extensive experience in premature ovarian failure treatment for women who want to get pregnant with POF. With POF, correct diagnosis (distinction from premature ovarian aging) and treatment decision with which each patient feels completely comfortable are the two main pillars of our treatment philosophy. 

What is Premature Ovarian Failure (POF)?

Women with Premature Ovarian Failure (POF) also known as Primary Ovarian Insufficiency (POI), is a loss of ovarian function before the age of 40. POF can affect women at various ages from teenage years to thirties. Women with POF are at a greater risk of a range of health issues, including osteoporosis, estrogen deficiency (hot flushes, vaginal dryness, etc.) and heart diseases. These POF-related issues can usually be managed well with hormonal replacement. However, in an infertility context, POF poses a challenge, as the loss of ovarian function means that the probability of pregnancy in women with POF is greatly reduced.

Although it is sometimes called early menopause, POF is different from menopause in that POF is not a result of natural (normal) aging process of a woman. Women with POF, in addition, may continue to have menstrual cycles, though their cycles will be irregular. A small percentage of women with POF can conceive naturally, while menopausal women will never get pregnant.

Diagnosis of Premature Ovarian Failure (POF)

Even if you have been told that you have POF, it may be too soon to despair. Quite often, we are surprised who is diagnosed with POF. Many patients with a supposed diagnosis of POF actually don't really suffer from POF. Many "POF" patients, when tested at our clinic, turn out to suffer from premature ovarian aging (POA), not POF.

While these two conditions sound similar, correct distinction between POF and POA is crucial. Women with POA can get pregnant: CHR physicians have demonstrated, and reported in the medical literature, remarkably good pregnancy results in women with even severe POA (with DHEA supplementation and proactive ovarian stimulation). For women with true POF, chances of pregnancy with their own eggs remain, however, unfortunately quite small. Pregnancy attempts in POF, therefore, always involve experimental treatments, as no effective treatment has so far been established for POF patients.

·         The diagnosis of POF or POI is made with FSH hormone blood testing, often supplemented with AMH levels and ovarian antral follicle counts.

·         An FSH level above about 30-40 indicates ovarian insufficiency.

·         The serum AMH level is low

·         The antral follicle counts are very low

Symptoms of Premature Ovarian Failure

·         Periods becoming more irregular and farther apart

·         Hot flashes

·         Night sweats

·         Thinning and drying of the vagina

Incidence of premature menopause

About 1-3% of women will experience menopause before the age 40 years and 5% before the age of 45 years. The incidence of premature ovarian failure or the early menopause is on the increase. Premature ovarian failure accounts for about 10% of amenorrhoea and 1% of all cases of infertility.

What are the causes of premature menopause?

In the majority of cases no cause can be found. However, tobacco use, null parity, and family history are associated with earlier menopause. Some of the known causes include:

·         Congenital, if the ovaries failed to develop and are absent from birth.

·         Chromosomal abnormalities, such as Turner's syndrome, where the ovaries contain only a few follicles.

·         Genetic (Fragile X premutation). Some women's ovaries run out of eggs long before their middle age. This is possibly due to an increased rate of disappearance of follicles. The incidence of familial premature ovarian failure (POF) varies from 4% to 30%. The risk of a female relative developing POF may be as high as 100% in familial POF and as low as 1% in sporadic cases. 

·         Autoimmune disease. Thyroid disease and Addison disease are common in women with premature ovarian failure. Ovarian antibodies act against the ovaries.

·         The ovaries are physically damaged by infections, such as the mumps, or by cancer treatment, such as radiotherapy or chemotherapy. This later group is increasing in number because of the longer survival of cancer patients due to advances in both diagnostic modalities and treatment available.

·         The ovaries were surgically removed because of cancer or other causes.

What fertility options are available for women with PMM?

At present, the only realistic chance of a pregnancy for women with premature menopause lies through egg donation.

·         Many fertility centers are now offering ovarian tissue freezing and storage for women with a positive family history of premature menopause. The aim is restoration of ovarian function through the transplantation of ovarian tissue. Although the technique of transplantation remains experimental, successful transplantations has been reported that ovarian function was restored within 120 days. Furthermore, they reported six pregnancies. Some centre described freezing of a whole ovary from six women (age 26-35 years) prior to cancer treatment.  After a storage period of between 17 and 32 months, ovarian transplantation was performed. In all cases, the transplanted tissue restored menstrual cycles within 20 weeks of the transplantation. Four of the six women conceived following assisted reproduction: two of the women delivered a single healthy child one woman miscarried.

·         Egg freezing and storage is another option for women with a positive family history of premature menopause and has no partner. Many IVF centers are currently offering egg freezing. Technological improvements in egg vitrification offer young healthy women the possibility of preserving eggs until the less fertile years of life. The best age for egg vitrification is probably under 30 years. However, unrealistic reliance on the store of vitrified eggs may lead some women to defer pregnancy for many years only to experience disappointment when the stored eggs later fail to fertilize or implant.

·         IVF with donated eggs and nuclear transfer is another possible future treatment. Here the nucleus of a healthy donor egg is replaced with the nucleus taken from a skin cell that 'would be a mother'. The donor egg is then fertilized by the male partner’s sperm and the resulting embryo is subsequently transferred into the recipient.

·         Embryo donation is another option if the male partner is also infertile.

Getting Pregnant with Premature Ovarian Failure

As already noted above, even in the best of hands, pregnancy in women with POF is a rare event, and most will end up having to use egg donation. Our clinic does offer experimental treatments to POF patients, but we usually recommend donor eggs as the treatment of choice. However, at our clinic, it is always the patient who decides which way she wishes to go.

Most POA patients, in contrast, will have an excellent pregnancy chance with use of their own eggs at Pahlajani Test Tube Baby Centre. Our center has gained a world-wide reputation for treating women with premature ovarian aging, and our center's widely published pregnancy rates, even in women with very severely diminished ovarian reserve, have resulted in an ever increasing number of POA patients, from all over the world, seeking treatment at our clinic. Our success in treating POA patients is primarily based on the introduction of DHEA supplementation into fertility treatment. Indeed, today seven years later DHEA is used worldwide; but DHEA, alone, is only part of comprehensive treatment approach to POA. For example, if a POA patient were to receive the wrong DHEA or was treated for an inappropriate length of time and, especially, if ovarian stimulation is not adjusted to the POA patient's needs, DHEA effects will be disappointing. In other words, DHEA alone has only limited effectiveness, but within a comprehensive treatment paradigm, it has truly revolutionized the treatment of women with diminished ovarian reserve.

Unfortunately, DHEA appears much less effective and maybe even not effective at all, in patients with outright POF. Very low pregnancy rates in our past DHEA study in POF patients showed us that pregnancy chances in POF patients would, at best, be affected by DHEA only in a much more limited way, in comparison to POA patients.

Premature Ovarian Failure and Pregnancy through Egg Donation

In our opinion, nobody should enter an egg donation cycle without being absolutely convinced that it is their only realistic chance of having a child. We, therefore, not only respect our patients' desire to "at least try once" with their own eggs, but actually encourage such attempts if patients still believe they have what looks to them like a reasonable chance. Definition of "reasonable," of course, varies between patients, and what one patient considers reasonable may be too low for somebody else. We do not feel that we can make these judgments for our patients. We, instead, see our responsibility in making certain that our patients have accurate and comprehensive information when making these decisions. Only the patients can decide what represents a "reasonable" chance for them! Once they decide, Pahlajani Test Tube Baby will do its best to maximize pregnancy chances, whatever treatment patients choose. Egg donation is, undoubtedly, the most successful treatment option for women with POF. With their own eggs, POF patients have a pregnancy chance, at most, in the low single digits. In our egg donor program, the same POF patient will have a cumulative pregnancy rate in the high 80s to low 90s, from a single egg donation cycle. Since about 95% of an embryo's quality derives from the egg, and egg donors are typically young, recipients of donated eggs will have the pregnancy chances and miscarriage risks of a young woman. Imagine if we could do this in other areas of medicine!

Does husband involvement & rigorous support makes IVF process more easy?

The process of infertility treatment requires a great degree of patience and mental strength. Not only for the couple that is undergoing the treatment, is it equally challenging for entire unit working for it in my team. Although I try to remain as neutral as possible during the treatment because it is necessary at my end, but still there are moments of distress and enjoyment that affect me up to some extent.

It is a fact that infertility treatment procedures and IVF primarily require physical and mental involvement of the female. However, participation of the father is equally necessary in relieving the stress of would be mother. It makes the relationship stronger and makes the bonding stronger. The couple feels more invested in the pregnancy.

There are various benefits of the involvement of husbands in the IVF process. I have detailed discussion with every couple during and after infertility treatment and try to understand their perception about the whole experience. We chat, discuss and analyze the phases we passed through together. There are a few feelings that come out prominently.

It’s not uncommon for the guy to feel a little left out of the mix during the IVF process. Look at the IVF process as a whole. Your wife or partner will be the one who has to go through the most testing, take all of the medications including the dreaded injections and has all of their hormones racing from the medications that she has been taking to prepare for the IVF procedure. This doesn’t even include the actual IVF procedure which includes the egg retrieval and the embryo transfer which is a huge physical, mental and emotional process that takes a toll on your partner. Needless to say, the female goes through a much harder IVF obstacle course than her husband or partner.

So, how do the guys keep in the mix of the whole IVF process? It’s Easy, provide support for your wife or partner during this emotional and physically challenging time. Stress and anxiety levels will be sky high so keeping your mate calm should be your number one focus. It’s natural to have stress during IVF but if you are there to comfort her and keep her mind at ease, the whole process will be much smoother for both of you.

A husband’s experience when going through an IVF cycle varies depending in large part on how involved he gets. When a husband participates actively with the IVF process it helps to relieve much of the stress on the wife and on the relationship. The more involved he is the more he will feel more invested in the entire experience and more in control over the outcome.

Many husbands complain that they feel left out of the whole IVF process as all the attention and care is apparently directed towards the woman. If anything they may feel that at best they can show up for the retrieval at which time they are expected to donate their sperm on demand. If you should fail at this then all the money, time, hope and efforts were wasted all because you choked when you could not even perform this one “simple” step. There is no witnessed the terror and horrors of war but have seen the devastation resulting from an IVF cycle failed as a result of a husband’s inability to collect a specimen. Relationships often do not survive in the wake of such a disappointment. 

Talk about performing under pressure, there is more at stake in the collection room than pitching in the World Series. Husbands and male partners view IVF from a different perspective than their wives. They are not the ones being injected with hormones; commuting to the physician’s office frequently over a two week span for blood tests and vaginal ultrasounds and undergoing a transvaginal needle aspiration procedure. At least women are involved in the entire process, speak with and see the IVF staff regularly and understand what they are doing and are deeply invested emotionally and physically in this experience. So what is a husband to do?

Many men learn to give their partners injections.  It helps involve them in the efforts and give them some degree of power over the process. They can relate better to what their partners are doing and take pride in contributing towards the common goal of achieving a baby.  The more involved a partner is the more support that is felt by the patient which is not only good for her emotionally but also helps in getting accurate information and directions from the office. It also helps to solidify their relationship. A man’s role in the IVF process is much less arduous when compared with the woman’s. 

In fact, the entire IVF process revolves around the woman. All these processes can be very exciting - and physically and emotionally stressful too. Many men think that their only job is to act as a ‘sperm donor’. While their wife is busy taking all the prescribed medicines and travelling to the clinic frequently for undergoing vaginal ultrasound scans, most men are totally clueless as to what is going on. They prefer to keep themselves detached. It’s not that they are unkind – it’s just that this is the commonest coping mechanism men deploy. This will make his wife feel lonely and abandoned in the process. She may jump to the erroneous conclusion that her husband does not care about her or about the deep desire she has for a baby. Actually, baby-making is exciting when both the partners’ involve themselves completely.

Those couples that appear to deal best with the stress of IVF are ones that do it together. Many husbands learn to give their wives the injections. It helps involve them in the efforts and give them some degree of control over the process. They can relate better to what their wives are doing and take pride that they are contributing towards the common goal of achieving the baby. When possible, husbands should accompany their wives to the doctor visits. They can interact with the staff, get questions answered and obtain a better understanding of what is going on. This not only makes women feel like their husbands are supportive but is helpful in getting accurate information and directions. Both of these things are so important that in a husband’s absence I would recommend that a surrogate such as a friend, sister, or mother be there if he cannot be. 

Support from him and others help diminish the level of stress and especially if it comes from the husband helps to solidify their relationship. Husbands should accompany their wives to the embryo transfer. This can be a highly emotional procedure. Your embryo/s is being placed in the womb and at least in that moment many women feel as if they are pregnant. Life may be starting here and it is wonderful for a husband to share this moment with his wife. Perhaps he may keep the Petri dish as a keepsake as the “baby’s first crib”.  

It is an experience a couple is not likely to forget as their first time together as a family. With regards to the pressure of performing to provide the specimen at the time of the retrieval, I would recommend that a husband freeze a specimen collected on a previous day when he does not have the intense pressure of having to produce at that moment or else. Having the insurance of a back up frozen specimen takes much of the pressure off at the time of retrieval making it that much easier to produce a fresh specimen. There are strategies that can be planned for special circumstances including arranging for assistance from your wife and using collection condoms so that the specimen can be collected during intercourse. Depending on the program these alternatives may be available.

Women are ruled by their hormones-especially during an IVF cycle! Because of all the drugs she is taking, there is being a hormonal roller-coaster going on inside her body. Some hormones drop, rise high and then drop again. These kinds of rapid changes in hormone levels can contribute to increased anxiety and depression in many women. Women can experience lots of crying spells and moodiness during this time. She might get irritated for no valid reason.

A husband’s experience when going through an IVF cycle varies depending in large part on how involved he gets. When a husband participates actively with the IVF process it helps to relieve much of the stress on the wife and on the relationship. 

The more involved he is, the more invested he will feel in the entire experience, and the more control he will feel over the outcome. Many husbands pride themselves in their new found skills of mixing medications and administering injections for their wives. It helps many men who are used to caring for their wives to be in control of administering the medication for them. Successful IVF then becomes something he played a very active role in, and he’ll relate better to the experience, his wife and the resulting baby.

Despite a lack of prior experience, most people can learn to prepare and administer the medication. Whether it is the feeling of “playing doctor” or the knowledge that he is contributing significantly in the process and supporting his wife, most men relate that giving their wives the injections was a positive experience for them and for their relationship.

During the ‘2ww’ many husbands tend to become overprotective. They want their wives to be careful about everything they do. Some don’t even want their wife to get out of bed! Although you might think that you are being kind and caring, this kind of overprotection can make your wife uncomfortable. Your actions might remind her all the time about the embryos inside her uterus. Once the embryos are inside the uterus, nothing she does will affect the chance of implantation. If the embryo is good enough and the uterine receptivity is optimum the embryo will implant - otherwise it will not! This is the only truth, as established by medical science.

Along the same line of thinking, accompanying your wife at the time of embryo transfer can be most rewarding. This can be a highly emotional procedure. Your embryo is being placed in the womb and at least in that moment many women feel as if they are pregnant. Life may be starting here and it is wonderful to share this moment with your wife. Perhaps you may keep the Petri dish as a keepsake as the “baby’s first crib”. It is an experience a husband and wife are not likely to forget as their first time together as a family. I strongly recommend that men don those scrubs, hats and booties and join their wives and partners as the physician transfers the embryos from the dish into her womb. Nine months later, do the same at delivery for memories that last a lifetime.

Does going through IVF causes premature menopause?

Many women worry that going through IVF will deplete their ovarian reserve, as a result of which they will run out of eggs, reduce their long-term fertility, and reach the menopause earlier. Logically, this makes sense. We all know that women are born with a certain number of eggs; and that their ovaries do not produce any new eggs after birth. If the doctor stimulates the ovaries to grow lots of eggs during the IVF treatment by giving hormonal injections, won’t this mean that there’ll be fewer eggs left in the ovaries after the IVF treatment – especially if they are doing many IVF cycles ? When going through IVF, the doctor harvests several eggs at the time of egg retrieval by stimulating the ovaries with hormones (FSH or a combination of FSH and LH). A woman with a menstrual cycle length of 28 days ovulate only 12 eggs per year. But women going through IVF produce 15 or more eggs at a time. Doesn’t this mean that IVF depletes the egg reserve faster than usual and can lead to earlier menopause?

The ovaries are a pair of organs situated in the pelvic region of women, one on each side. They act as the reservoir for our eggs. Eggs are the cells which carry half of the information (genetic blue print) necessary for creating a baby. Such precious egg cells are stored, nourished and protected within specialized structures in ovaries called follicles.  A female fetus at around 18-22 weeks of gestation contains about 2,000, 000 follicles in its ovaries and each follicle contains one egg. At the time of birth, a girl has only about 3,00,000 egg left in her ovaries – she’s lost over 80% of her eggs even before being born. 

The remaining follicles continue to get depleted during her life time; and when there are only about 1000 follicles left, she reaches menopause. A woman normally ovulate only about 400 eggs during her lifetime, releasing one mature egg each month, from the time of attaining puberty until reaching menopause. An ovary contains several immature follicles (and hence several eggs!) but not all these follicles will become mature enough to release a functional egg. More than 99.99 % of the follicles (and hence the eggs) are simply lost, without serving their biological purpose.  Human reproduction is remarkably inefficient.

During each menstrual cycle, several ovarian follicles start growing in response to the FSH secreted by the pituitary gland. Of these recruited follicles, only one follicle grows to maturity, and this is called the dominant follicle.  It carries the mature egg which will be released during ovulation. The other follicles which fail to reach maturity are lost . They die, and this natural process is called atresia. During IVF treatment our body is supplied with high amounts of FSH (several folds higher than our body naturally produces), in the form of injections. This high amount of FSH helps to rescue more of the follicles which are recruited during that particular menstrual cycle. This is the reason why IVF specialists are able to harvest several eggs during an IVF treatment. 

This is also the reason why IVF treatment will not deplete your ovarian egg reserve. The follicles and the eggs inside them which would normally have died during that particular menstrual cycle are being rescued during an IVF cycle. This is why an IVF treatment will not cause you to go through menopause earlier. This is true even if you do many IVF cycles.

However, do remember that many infertile women are at increased risk for having poor ovarian reserve and reaching menopause early, whether they do IVF or not; this maybe because they have endometriosis, or because they have undergone laparoscopic surgery.  If they reach menopause earlier than expected after having taken IVF treatment, they are quite naturally going to blame the IVF treatment for this – whereas the reality is that they would have reached the menopause early anyway, even if they had not done IVF.

Women who have undergone IVF treatment often fear that they will reach menopause early. Now however, they can breathe a sigh of relief, for a new study has said that IVF does not cause early menopause or even more severe menopausal symptoms. One of the study dealing with the long-term effects of IVF treatment, and was conducted by a team of researchers. The study involved almost 200 women who were among the first to undergo IVF, which involved a far heavier drugs regime. 

It was discovered that their menopause started at the same age as the national average, i.e. the average of just over 50. The belief that IVF could bring on the menopause early is due to the fear that ovary-stimulation for releasing the eggs required for treatment might bring about their speedy decline. 

Doctors have long been against this notion but there wasn't any clinical evidence to prove the same. They found that the participants' menopausal age was quite similar as that of their mother. Also, there wasn't any increase in menopausal symptoms with the number of treatments, even though their results were not compared with non-treated controls. It was unknown territory in those days. Although all the studies showed that the treatment was safe, it was ground-breaking and we couldn't predict the potential long-term impacts. 

Overall, follicle stimulation "appears to have no lasting impact on the timing or symptoms of the menopause. Since many of the women received multiple treatment cycles and large doses of drugs, the current trend towards milder stimulation should have no effect either, which is reassuring for the future. This is a question patients often ask - and it's very useful to finally have point to which offers them reassurance that IVF will not affect the timing or severity of the menopause."

Comprehensive vision of Success rate, Issues and Expectation from IVF

IVF is never the first step in the treatment of infertility. Instead, it's reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven't worked.

If you think that IVF might make sense for you, carefully assess any treatment center before undergoing the procedure. Here are some questions to ask the staff at the fertility clinic:

·         What is your pregnancy ratio per embryo transfer?

·         What is your pregnancy rate for couples in our age group and with our fertility problem?

·         What is the live birth rate for all couples who undergo this procedure each year at your facility?

·         How many of those deliveries are twins or other multiple births?

·         How much will the procedure cost, including the cost of the hormone treatments?

·         How much does it cost to store embryos and how long can we store them?

·         Do you participate in an egg donation program?

What Can I Expect From IVF?

The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one. You will then be tested to determine whether you're ready for egg retrieval.

Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won't develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.

During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour.

Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner's sperm, which he will have donated on the same day.

While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage.

Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring three or four embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.

Following the procedure, you would typically stay in bed for several hours and be discharged four to six hours later. Your doctor will probably perform a pregnancy test on you about two weeks after the embryo transfer.

In cases where the man's sperm count is extremely low, doctors may combine IVF with a procedure called intracytoplasmic sperm injection. In this procedure, a sperm is taken from semen -- or in some cases right from the testicles -- and inserted directly into the egg. Once a viable embryo is produced, it is transferred to the uterus using the usual IVF procedure.

What Are the Success Rates for IVF?

Success rates for IVF depend on a number of factors, including the reason for infertility, where you're having the procedure done, and your age. Statistics for all assisted reproductive technology (ART) procedures performed including IVF, GIFT, and ZIFT, although IVF is by far the most common; it accounts for 99% of the procedures.

·         Pregnancy was achieved in an average of 29.4% of all cycles (higher or lower depending on the age of the woman).

·         The percentage of cycles that resulted in live births was 22.4% on average (higher or lower depending on the age of the woman).

Are There Other Issues With IVF to Consider?

Any embryos that you do not use in your first IVF attempt can be frozen for later use. This will save you money if you undergo IVF a second or third time. If you do not want your leftover embryos, you may donate them to another infertile couple, or you and your partner can ask the clinic to destroy the embryos. Both you and your partner must agree before the clinic will destroy or donate your embryos.

A woman's age is a major factor in the success of IVF for any couple. For instance, a woman who is under age 35 and undergoes IVF has a 39.6% chance of having a baby, while a woman over age 40 has an 11.5% chance. However, the success rate is increasing in every age group as the techniques are refined and doctors become more experienced.