IVF stands for In Vitro Fertilization. It’s a process where fertilization of an egg and sperm occurs outside the body, typically in a laboratory dish (“in vitro” means “in glass” in Latin). After fertilization, the resulting embryo(s) are then transferred to the uterus to establish a pregnancy. This technique is commonly used to help couples with fertility issues conceive a child.

Additional Options

• Embryo Freezing: Extra embryos can be frozen for future use.
• PGT (Preimplantation Genetic Testing): Tests embryos for genetic conditions before transfer.
• Donor Eggs/Sperm: Used if needed.

Success Rates

Success depends on factors like age, egg quality, sperm health, and underlying fertility issues.

• Under 35: ~50% per cycle
• 35–37: ~40% per cycle
• 38–40: ~25% per cycle
• Above 40: ~10–15% per cycle

IUI (Intrauterine Insemination) is a fertility treatment that involves placing sperm directly into a woman’s uterus to increase the chances of fertilization. It’s a simpler, less invasive, and less expensive procedure compared to IVF or ICSI.

When is IUI Used?

IUI is commonly recommended in the following situations:

1. Mild Male Factor Infertility:

   • Low sperm count or reduced sperm motility.

2. Unexplained Infertility:

   • When no clear cause for infertility is found after standard tests.

3. Cervical Mucus Issues:

   • Hostile cervical mucus that prevents sperm from reaching the egg.

4. Ovulation Problems:

   • For women with irregular ovulation, IUI can be paired with ovulation-stimulating medications.

5. Donor Sperm:

   • Used in cases where donor sperm is needed, such as for single women or same-sex couples.

6. Sexual Dysfunction:

   • When intercourse is not possible due to physical or psychological reasons.

7. Mild Endometriosis:

   • Helps bypass potential barriers caused by endometriosis.

Azoospermia is a medical condition where there is an absence of sperm in the ejaculate, making natural conception impossible without medical intervention. It affects about 1% of men and accounts for 10–15% of cases of male infertility.

Types of Azoospermia

Azoospermia is categorized into two main types based on the underlying cause:

1. Obstructive Azoospermia (OA):

   • Caused by a physical blockage in the male reproductive tract.
   • The testicles produce sperm, but the sperm cannot exit due to a blockage or absence of ducts.
   • Common causes include:
     • Vasectomy.
     • Congenital absence of the vas deferens (often associated with cystic fibrosis).
     • Scarring or blockages due to infections or surgeries.

2. Non-Obstructive Azoospermia (NOA):

   • Caused by impaired sperm production in the testicles.
   • The issue is often related to hormonal imbalances, genetic factors, or damage to the testicles.
   • Common causes include:
     • Genetic disorders (e.g., Klinefelter syndrome, Y chromosome microdeletions).
     • Hormonal issues (e.g., low FSH or testosterone levels).
     • Testicular damage from radiation, chemotherapy, or trauma.
     • Undescended testicles (cryptorchidism).

Symptoms of Azoospermia

• No visible symptoms in many cases.
• Possible signs:
  • Low ejaculate volume.
  • Hormonal symptoms, such as low libido or reduced facial/body hair (if hormonal imbalances are involved).
  • Pain or swelling in the scrotum (in obstructive cases).

Diagnosis of Azoospermia

1. Medical History and Physical Examination:

   • Reviewing past medical conditions, surgeries, and lifestyle factors.
   • Checking for physical abnormalities, such as testicular size or scarring.

2. Semen Analysis:

   • Confirms the absence of sperm in the ejaculate (performed multiple times for accuracy).

3. Hormonal Testing:

   • Measures levels of FSH, LH, testosterone, and prolactin to assess testicular and hormonal function.

4. Genetic Testing:

   • Checks for genetic abnormalities, such as Y chromosome microdeletions or Klinefelter syndrome.

5. Scrotal Ultrasound:

   • Identifies blockages, varicoceles, or structural issues in the reproductive tract.

6. Testicular Biopsy:

   • A small tissue sample from the testicles helps determine if sperm production is occurring.

Treatment Options

Treatment depends on whether the condition is obstructive or non-obstructive:

For Obstructive Azoospermia:

1. Surgical Correction:
   • Reversing vasectomy or repairing blockages in the reproductive tract.
2. Sperm Retrieval Techniques:
   • TESA (Testicular Sperm Aspiration): Directly retrieves sperm from the testicles.
   • PESA (Percutaneous Epididymal Sperm Aspiration): Retrieves sperm from the epididymis.
3. Assisted Reproductive Technologies (ART):
   • Sperm retrieved surgically can be used for ICSI (Intracytoplasmic Sperm Injection) in an IVF cycle.

For Non-Obstructive Azoospermia:

1. Hormonal Therapy:
   • Correcting hormonal imbalances (e.g., low testosterone or high prolactin).
2. Sperm Retrieval:
   • If there is limited sperm production, techniques like Micro-TESE (Microsurgical Testicular Sperm Extraction) may locate and retrieve sperm.
3. Donor Sperm:
   • In cases where no sperm is retrievable, donor sperm can be used for conception.
4. Lifestyle Modifications:
   • Improving diet, reducing stress, avoiding smoking/alcohol, and managing chronic conditions.

Prognosis and Success Rates

• Obstructive Azoospermia: Good prognosis, as sperm retrieval is often successful, and ART techniques like ICSI can result in high success rates.
• Non-Obstructive Azoospermia: Depends on the underlying cause, but advanced sperm retrieval techniques offer hope in some cases.

PGD (Preimplantation Genetic Diagnosis) is a procedure used in conjunction with IVF (In Vitro Fertilization) to screen embryos for specific genetic conditions or chromosomal abnormalities before they are transferred to the uterus. It helps identify embryos that are free of inherited genetic disorders, increasing the likelihood of a healthy pregnancy.

Purpose of PGD

PGD is primarily used to:

1. Prevent Genetic Disorders:
   • Identifies embryos with genetic mutations associated with inherited diseases (e.g., cystic fibrosis, sickle cell anemia, Huntington’s disease).
2. Reduce Risk of Miscarriage:
   • Screens for chromosomal abnormalities (e.g., aneuploidy) that might lead to pregnancy loss.
3. Increase IVF Success Rates:
   • Ensures only healthy embryos are implanted, improving the chance of a successful pregnancy.
4. HLA Matching:
   • Matches embryos with specific tissue compatibility to help siblings requiring bone marrow or stem cell transplants.

When is PGD Recommended?

PGD is commonly used in the following cases:

1. Genetic Risk Factors:

   • Couples who are carriers of single-gene disorders (e.g., cystic fibrosis, Tay-Sachs disease).
   • History of genetic diseases in the family.

2. Recurrent Pregnancy Loss:

   • Miscarriages due to chromosomal abnormalities.

3. Advanced Maternal Age:

   • Women over 35, as they are at higher risk of having eggs with chromosomal abnormalities.

4. Severe Male Factor Infertility:

   • In cases where sperm abnormalities may increase the risk of chromosomal defects.

5. History of Failed IVF Cycles:

   • To identify the healthiest embryos for transfer.

The PGD Process

PGD involves several steps:

1. IVF Process

• Eggs are retrieved from the ovaries and fertilized with sperm in a laboratory.

2. Embryo Development

• The fertilized eggs are cultured in the lab for 5–7 days, developing into blastocysts.

3. Biopsy

• A few cells are carefully removed from the developing embryo, usually at the blastocyst stage.
• The biopsy doesn’t harm the embryo’s ability to implant and grow.

4. Genetic Testing

• The biopsied cells are analyzed for:
  • Single-Gene Disorders: Specific mutations linked to inherited diseases.
  • Chromosomal Abnormalities: Extra or missing chromosomes (e.g., Down syndrome, Turner syndrome).
  • HLA Matching: For specific tissue compatibility.

5. Embryo Selection

• Only embryos free of the targeted genetic or chromosomal issues are selected for transfer.

6. Embryo Transfer

• The healthiest embryo(s) are implanted into the uterus to establish pregnancy.

Benefits of PGD

1. Reduces Risk of Genetic Disorders: Ensures only healthy embryos are used for implantation.
2. Increases IVF Success Rates: By selecting chromosomally normal embryos, the chances of successful implantation and pregnancy improve.
3. Improves Pregnancy Outcomes: Reduces miscarriage rates by avoiding embryos with abnormalities.
4. Offers Family Balancing: (If legally permitted) PGD can identify the sex of the embryo.

Risks and Limitations of PGD

1. Embryo Damage: The biopsy process carries a small risk of harming the embryo.
2. Accuracy: While highly accurate (95–98%), PGD is not 100% foolproof.
3. Limited Testing Scope: Can only test for conditions specifically targeted.
4. Ethical Concerns: Some individuals have moral or ethical objections to embryo testing and selection.
5. Cost: PGD is expensive and adds to the overall cost of IVF treatment.

Difference Between PGD and PGT-A

• PGD: Focuses on screening for specific genetic disorders or mutations.
• PGT-A (Preimplantation Genetic Testing for Aneuploidy): Looks for chromosomal abnormalities in general, such as missing or extra chromosomes.

Would you like more information about PGD costs, success stories, or how it compares to other genetic testing methods?

Surrogacy is an arrangement in which a woman (the surrogate) agrees to carry and give birth to a child for another person or couple (the intended parents). It is often used when the intended parents cannot conceive or carry a pregnancy themselves due to medical, genetic, or other reasons.

Types of Surrogacy

There are two main types of surrogacy, based on the source of the egg used:

1. Traditional Surrogacy

   • The surrogate uses her own egg, making her the biological mother of the child.
   • The sperm is provided by the intended father or a donor, and conception is achieved through artificial insemination (IUI) or IVF.
   • Traditional surrogacy is less common due to legal and emotional complexities.

2. Gestational Surrogacy

   • The surrogate has no biological connection to the child.
   • An embryo is created using the egg and sperm of the intended parents or donors through IVF, and then implanted in the surrogate’s uterus.
   • This is the more common and widely accepted form of surrogacy.

Who Needs Surrogacy?

Surrogacy is an option for individuals or couples facing the following challenges:

1. Medical Conditions:

   • Uterine abnormalities, such as absence of the uterus (congenital or due to surgery).
   • Severe scarring of the uterus from previous surgeries or infections.

2. Repeated Pregnancy Loss:

   • History of recurrent miscarriages despite medical intervention.

3. Infertility:

   • Women unable to conceive or carry a pregnancy after multiple fertility treatments.

4. Health Risks:

   • Women with medical conditions (e.g., heart disease, kidney disease) where pregnancy could endanger their health or life.

5. Same-Sex Couples:

   • Male same-sex couples require a surrogate (along with an egg donor) to have a biological child.

6. Single Parents:

   • Single men or women who wish to have a biological child may opt for surrogacy.

The Surrogacy Process

Surrogacy involves several key steps:

1. Finding a Surrogate

• Surrogates can be identified through:
  • Surrogacy agencies.
  • Known individuals (e.g., family or friends).

2. Screening the Surrogate

• Medical evaluation: To ensure the surrogate is physically healthy and capable of carrying a pregnancy.
• Psychological evaluation: To assess emotional readiness and understanding of the process.

3. Legal Agreements

• A legal contract is signed between the surrogate and the intended parents to outline responsibilities, compensation, and parental rights.

4. IVF and Embryo Transfer

• The surrogate undergoes IVF to receive the embryo.
• The embryo is created using the intended parents’ egg and sperm, or donor gametes.

5. Pregnancy Monitoring

• The surrogate is monitored throughout the pregnancy to ensure the health of the baby and surrogate.

6. Birth and Transfer of Parental Rights

• After the child’s birth, legal procedures are followed to transfer custody to the intended parents.

Legal Aspects of Surrogacy

Surrogacy laws vary widely by country and even within regions of a country. Key points include:

1. Commercial Surrogacy vs. Altruistic Surrogacy:

   • Commercial Surrogacy: The surrogate receives financial compensation beyond medical expenses.
   • Altruistic Surrogacy: The surrogate is compensated only for medical and pregnancy-related costs.

2. Legality:

   • Some countries prohibit surrogacy entirely, while others regulate or allow only altruistic surrogacy.
   • Intended parents should ensure compliance with local laws and establish clear legal agreements.

Advantages of Surrogacy

1. Biological Connection:
   • In gestational surrogacy, the child is genetically related to one or both intended parents.
2. Option for Non-Traditional Families:
   • Enables same-sex couples and single parents to have biological children.
3. Solution for Medical Challenges:
   • Offers a pathway to parenthood for individuals unable to carry a pregnancy.

Challenges of Surrogacy

1. High Cost:
   • Surrogacy can be expensive, especially in countries that allow commercial surrogacy.
2. Legal and Ethical Concerns:
   • Laws and regulations can complicate the process, and ethical debates may arise.
3. Emotional Complexity:
   • The surrogate and intended parents may face emotional challenges during and after the process.

Cost of Surrogacy

Costs vary depending on the country, the type of surrogacy, and additional factors like IVF, legal fees, and surrogate compensation.

• Gestational Surrogacy: $50,000–$150,000 or more, depending on location and circumstances.

Would you like more information about surrogacy laws, ethical considerations, or finding a surrogacy agency?