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Many fertility clinics do ovarian reserve tests to evaluate women who are dealing with infertility and prior to undergoing In Vitro fertilization (IVF).  It can be used to estimate how fertile a woman is.  The results of these tests can help the doctor find out if the number of eggs is normal for that age and also to determine how much medication should be given to stimulate the ovary to produce multiple eggs.

What is ovarian reserve?

Every woman is born with all of the eggs she will ever have in her whole life (around 1 to 2 million) which means this quantity will be constantly decreasing until menopause.  By the time the woman reaches puberty, many follicles die off and this number goes down to around three to four hundred thousand.  Of these, only about 300-400 will actually mature over a woman’s lifespan.  Only at puberty, a certain part of the brain called the hypothalamus begins releasing certain hormones to stimulate some of the follicles to grow.  Follicles in the ovary start off very small as primordial follicles which contain the oocytes and lay dormant and which are too small to be seen by ultrasound.  Antral follicles are bigger follicles and measure between 2 and 10 mm and can be visible by ultrasound.  At each menstrual cycle, a few of these immature eggs enclosed in the follicle will have the potential to respond to hormones, mature and then usually only one egg will be released (ovulation) each month while the rest disintegrate.  As you age especially after 37 years, the number of follicles lost to attrition is accelerated and the quality of the eggs also decrease with age. The quality and quantity of these follicles in the ovary are called the ovarian reserve and establishes the woman’s potential to procreate.  Other than age, various other factors can decrease fertility like undergoing cancer treatment, certain genetic disorders, going through premature menopause, ovarian surgery, endometriosis, polycystic ovary syndrome(PCOS), obesity, stress, and smoking amongst other things.

What are the various ovarian reserve tests?

1. Anti Mullerian Hormone (AMH) levels-reflect the number of growing follicles that can potentially ovulate and is the preferred test for determining the ovarian reserve. AMH is made by the cells inside the growing follicles which contain the egg. It can be done by a simple inexpensive blood test.  The level of AMH in a woman’s blood is stable throughout the menstrual cycle hence the blood sample can be taken at any time for testing. There are standard AMH levels for different age groups, and like your number of eggs, the AMH levels will also decline as you age. So very low AMH levels suggest decline in ovarian reserve.  However a very high level is suggestive of polycystic ovary syndrome(PCOS) which is a hormonal disorder and can also affect fertility.  That makes it a good indicator of fertility when considered along with the other tests.  Having low AMH levels might explain why it might be more difficult to get pregnant, but pregnancy can still happen because it only takes one healthy egg to combine with a sperm to form an embryo and begin conception.
2. Basal follicle stimulating hormone(FSH) levels- are determined by a simple blood test and it is a hormone released by the brain that stimulates a few follicles to develop and mature.  Its often done between days 2 to 4 of the cycle because estradiol (type of hormone estrogen) levels are at its lowest and estradiol tends to suppress FSH levels.  FSH can erroneously look normal if estradiol is too high.  So FSH level test are often done together with estrogen tests. If the FSH levels are high, it means that the brain needs to send higher FSH levels to stimulate the ovaries which in turn could indicate lower ovarian reserve.  However, there is no standard level that is accepted universally that is thought to be the cutoff value for a poor response.  Ovarian aging begins several years before any FSH level elevation and it cannot thus predict this for some women.  So one needs to look at the combined results from other tests too.
3. E2 or estradiol test- should also be done between days 2 to 4 of the menstrual cycle by a blood test.  As the follicles grow and mature, the hormone estradiol will be increasingly released from the ovaries so that there are not too many mature eggs.  If the estradiol levels are very high, it may be an indicator of low ovarian reserve.  Estradiol tests are done to see if FSH levels are accurate.  If FSH levels are normal but estradiol levels are high it means that there could be a problem with the ovarian reserve or its suppressing FSH levels.  Low estradiol levels could indicate problems due to PCOS, menopause, having eating disorders or doing excessive exercise which could all in turn affect fertility.
4. Antral follicle count (AFC) – are measured by ultrasound where the probe is placed in the vagina and it to is done between days 2 to 4 of your cycle to count the number of antral follicles in both ovaries.  Antral follicles are follicles that have been recruited for ovulation out of which only one egg is eventually released during ovulation.  The number of antral follicles decreases with age and it can also be used to help predict how many eggs a woman will produce if she undergoes IVF.  However, AFC only represents the number of follicles that can be seen in the ultrasound and not the smaller follicles that have yet to grow.  So a low AFC is indicative of lower ovarian reserve.

Does BMI affect ovarian reserve

Body Mass Index (BMI) is a predictor of your body fat by dividing your weight in kg with your height squared (m2).  A BMI of more than 25 is considered overweight while over 30 is considered obese.  Even though it’s a useful tool, it cannot differentiate between fat and muscle.  So a very fit individual might have a higher BMI.  Thus, the doctor may also have to look at other parameters like measuring their girth or if they have more fat in their stomach region.   There are conflicting results from studies looking at the relationship between obesity and ovarian reserve.   One study found that AMH and FSH levels are significantly lower in obese than in non obese women. (3) Yet another study found no significant difference in AMH, E2 and FSH parameters between women with high BMI and waist circumference and those in the normal range. (4)  However, it was also found that women with high BMI had higher chances of having irregular cycles or no periods at all.  They also had decreased chances of pregnancy.  Losing some weight through better nutrition and exercise can improve the chances of conception. Obesity may affect ovarian response, requiring a higher dose of clomiphene citrate or follicle-stimulating hormone (FSH) to trigger ovulation.  Obesity in men can also lead to fertility issues as it can affect sperm function and count.As noted above, there is no single test in isolation that can give an completely accurate picture of ovarian reserve and fertility. Therefore, a combination of various tests are used by specialists to improve their assessment of what is going on.  The specialists are Xenith Advanced Fertility Centre are very knowledgeable in this field and if you are struggling for answers, please come talk to them in order to move forward and improve your chances of pregnancy.

Miscarriage is the loss of pregnancy before the 20^th week and it can be a traumatic time in your life In many circumstances there might not be any reason for its occurrence, making it very hard to cope with the waves of sadness interspersed with the question of why it happened and feelings of guilt.  Miscarriages are quite common even in healthy women and its almost never caused by something the person did.  A miscarriage usually happens in the earlier part of the pregnancy because 80% of the miscarriages happen in the first 3 months. (1)  However, most women who have had a miscarriage go on to have a normal pregnancy after that. Sometimes, a woman can have a miscarriage in the first week or two without even realizing she’s pregnant and it may seem like period just came late.

Symptoms of a miscarriage might include bleeding, severe cramps, belly and or back pain, fever, contractions, blood clots passing from your vagina amongst other signs.

Cause of miscarriage

1. Genetic or chromosomal abnormality- Each person has 46 chromosomes and if something goes wrong randomly when the cells are dividing leading to missing or repeated chromosomes, it can cause a miscarriage.  About 50 percent of all first trimester miscarriages are because of chromosomal abnormalities. (2) This happens more often as the woman gets older.
2. Certain illnesses- like severe diabetes, thyroid problems, heart disease, hypertension are just some of the illnesses that may lead to miscarriage.  Clotting disorders like lupus can form clots in the placenta preventing much needed nutrition from reaching the baby and waste to be taken away.
3. Certain infections- like herpes, listeria and rubella can pass through the placenta to the fetus and harm it.  Other infections of the uterus or cervix could also cause miscarriage.
4. Defects in the structure of the uterus cavity or cervix as well as presence of fibroids- may lead to an inability to go through a healthy pregnancy.  Sometimes a weak cervix, which is also called cervical insufficiency, cannot hold the pregnancy and this usually occurs in the second trimester.
5. Major injury- A fall in the first trimester most probably will not lead to a miscarriage because the uterus wall is still thick and the pelvic bones will protect the tiny embryo.  In the second trimester, a lot of amniotic fluid surrounding the fetus could also provide protection.  Very major impacts which is a rare happening can lead to a miscarriage.
6. Age- The rate of miscarriage is high in women in their late 30s or older. (3)
7. Lifestyle choices- like smoking, drinking alcohol, using street drugs or being exposed to radiation or toxic substances. 
8. Medications– certain medications like  certain antibiotics, steroids, retinoids used for treating severe acne, as well as medications for rheumatoid arthritis are just some medications that may increase your risk of miscarriage.  Always consult with your doctor before taking any medications.
9. If you have had 2 or more miscarriages in a row- you are more likely to have another miscarriage.  Your doctor might recommend doing some blood tests, chromosome tests, ultrasound to see if there are any issues with the uterus, pelvic exam or various other tests to see if there are any reasons for your miscarriages. It could also be due to an autoimmune response. (4)

Myths about miscarriage:

1. Sudden shock or fright during pregnancy doesn’t cause miscarriage.
2. Minor injuries don’t lead to miscarriage.
3. Exercise- during pregnancy is not linked to miscarriage.  In fact, it is better to stay active during pregnancy to decrease the chances of gestational diabetes or having high blood pressure. Have a discussion with your doctor if you want to do some high intensity exercise.
4. Straining or lifting do not increase risk of miscarriage.
5. Being emotional or getting stressed is not linked to higher risk of a miscarriage.  Mood changes during pregnancy can happen due to fatigue, or changes in hormone levels.
6. Working during pregnancy is not associated with increased risk of miscarriage although make sure you aren’t exposed to radiation or certain chemicals at work. 
7. Having sex during pregnancy cannot lead to a miscarriage as long as you don’t have any preexisting conditions like placenta previa or preterm labor
8. Air travel is considered safe during pregnancy although many airlines don’t allow travel after the 36th week of pregnancy.
9. Eating hot and spicy food does not lead to a miscarriage.
10. You should wait for some time preferably 2- 3 months before trying to get pregnant again.  However depending on how early the miscarriage happened, you could start trying as soon as after your first period.  But consult with your doctor as to your physical and mental health before trying again.

If you have had an early miscarriage, get in touch with your doctor before planning your next pregnancy. If during the pregnancy you have severe pain or heavy bleeding, it could be a sign of threatened miscarriage, so consult your doctor immediately. At times if after the miscarriage heavy bleeding with or without passage of clots continues the doctor might need to remove any remaining fetal tissue in the uterus.  You might also be given medication to speed up the removal of any tissue.  The doctor might also do a follow up by asking you to do some blood tests and ultrasound to be sure no tissue from the pregnancy remains in your body.

A single miscarriage can happen in 15% of pregnant women and usually a lot of work up is not necessary after a single miscarriage, though after two miscarriages a thorough workup is indicated.   Try to stay positive and focus on your physical and emotional health.  You could lead a healthy lifestyle like eating healthy foods, avoiding smoking and drinking alcohol.  Getting moderate exercise can definitely help keep your body and mind healthy.  If you do get pregnant, get regular prenatal checkups from your doctor. You might experience a range of emotions following a miscarriage and its absolutely okay to feel this way.  It might help to talk to your partner, close friend, family or a professional counselor or joining a support group to vent your feelings and know that it’s not your fault.  Take time to heal physically and emotionally before trying again.  There is nothing to be ashamed about since it’s not your fault.  Everyone heals differently and make sure you take your time to decide what to do next.  Talk to your doctor as well about your next steps.  If you have experienced one or several miscarriages, come talk to us at Xenith Advanced Fertility Centre and we can help you have a successful pregnancy outcome.

Male infertility occurs if problems in conception are due to an issue in the reproductive capability of the male.  Male infertility could be due to an issue with the sperm itself or a problem with its delivery into the woman’s vagina.  The testicles produce the sperm and are also responsible for secreting the hormone testosterone which is thought to regulate the sex drive in men amongst other things.

There are many reasons for male infertility some of which could be due to low sperm count, decreased sperm motility, abnormally formed sperm, blocked sperm ducts, illnesses, injuries, lifestyle choices, health issues or various other reasons.  Sometimes sperm are affected temporarily due to injury of the testicles or due to drug abuse, smoking or drinking too much alcohol.  Fertility could also be impacted by age.  Also, sometimes infertility in men could be unexplained because routine tests seem to be within normal levels. This can at times  be due to fragmentation in the sperm DNA for which advanced tests are needed.

Symptoms

Male infertility symptoms can be sometimes vague and one might not even know they are infertile until they are having problems conceiving and go to see a doctor.  Some symptoms might include:

1. Problems with ejaculation- occurs if ejaculation doesn’t occur at all or occurs too early or too late.  Sometimes, there might be low volume or no semen during ejaculation.  Retrograde ejaculation occurs when the semen goes backward into the bladder rather than out of the penis leading to problems with conception.
2. Reduced or no sexual desire- could be due to hormonal issues like a decrease in testosterone levels.  It could also be due to chronic stress, fatigue or depression.
3. Testicles are very small- could be due to various reasons like trauma, undescended testes (the testicles don’t move down into the scrotum before birth itself), testicular torsion (where testicle rotates within its sac and blocks its own blood supply) or hypogonadism (body doesn’t produce enough testosterone). It could also be due to varicocele where veins within the scrotum get enlarged usually due to problems with blood flow and it may look like a bag of spaghetti with one testicle smaller than the other. This occurs due to valves in the testicular vein not functioning properly allowing blood to get pooled in the scrotum.  Having small testicles or different sized testicles does not necessarily mean that there is an issue.  However, a sudden change in shape or size of testicles might indicate a problem.
4. Erectile dysfunction- is the inability to maintain an erection during sexual intercourse and could be due to various reasons like heart disease, diabetes, obesity, high blood pressure, prostate problems, drug use, depression, hormonal issues amongst other reasons.
5. Pain, swelling or a lump in and around the testicles- could be due to many reasons like infection, twisted testicles, fluid buildup around testicles or hernia.  You should seek immediate medical attention if you have these symptoms.
6. Obstruction in the testicles- not allowing the sperm to travel through the tubes and nothing coming out during ejaculation could be due to infection, surgery like vasectomy, or a defect during development. 
7. Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality

Treatment

Treatment depends on what’s causing the infertility. Many problems can be fixed with medication or surgery. This could allow for conception through normal sex.

1. Surgery for varicoceles- Varicoceles are repaired with surgery to block off the abnormal veins. This might improve fertility.
2. Lifestyle choices– like no drugs, smoking or alcohol can aid in issues with fertility.  Avoid hot baths or whirlpools because high temperature can affect sperm.  Get adequate sleep, exercise and eat healthy.  Certain medications like steroids can also affect infertility.
3. Hormonal abnormalities like hypogonadism, can sometimes be treated with hormone replacement therapy
4. Obstructions in sperm travel can sometimes be fixed by surgery. Transrectal ultrasound could be used to see if there is any blockage or unusual structures causing problems.
5. Assisted reproductive techniques(ART) like IVF could be used to collect, wash and concentrate sperm and could aid in conception to help men with very low amounts of sperm.  If no sperm is coming out, they could be collected from testicles in case of blockage or from the bladder or urine in case of retrograde ejaculation.
6. Remove stress, anxiety- if one is able to ejaculate normally but not during sex, then it might be a psychological issue.  It might help to have an open and frank discussion with your partner and this might relieve some anxiety and help resolve your issue.
7. 7)     Medications could be used for treating erectile dysfunction
8. Certain medications that you are taking for some previous underlying health condition, might itself be causing infertility like medications for arthritis, depression, high blood pressure, cancer or other problems.
9. In many cases, an undescended testicle moves into the proper position on its own within the first few months after birth.  If it doesn’t, surgery might be needed to move the undescended testicle to the proper location.

Many men might feel embarrassed about problems with sexual health and may thus avoid seeing a doctor.  It is important to seek medical treatment because it may be due to some serious underlying condition.  At Xenith Advanced Fertility Centre, we value your privacy and can help you find answers to your issues with infertility and help you in having a child. We have a specialized Andrology Clinic, where it is not just about infertility in the male and all advanced options for treating it, but also for other issues such as erectile problems, ejaculatory disorders etc.

Intrauterine insemination (IUI) is a type of non-invasive treatment for infertility where the sperm are introduced directly into the woman’s uterus when she is ovulating.  In natural conception, the sperm travel from the vagina through the cervix, into the uterus and up through the fallopian tubes to meet the egg which is released from the ovaries.  IUI just gives an extra little help to this natural process by the sperm being cleaned and concentrated and then placed directly into the uterus closer to the fallopian tubes and the egg.  This shortens the journey the sperm has to make to the egg. It also ensures that sperm is in the body at the best possible time for conception.  If IUI is unsuccessful after a few attempts, then one may have to try the more expensive Invitro fertilization (IVF) route.

IUI is usually recommended for people dealing with unexplained fertility, issues with sperm motility or quantity, issues with cervical mucus or the cervix, mild endometriosis, issues with ejaculation or few other reasons. 

IUI procedure

1. What to expect before the procedure

Upon visiting the fertility specialist, you will be asked detailed questions about your medical history and how long you have been trying to get pregnant.  So take any paperwork that gives this information and have on hand, any relevant dates that might be helpful.  A physical exam will also be performed during this time for the doctor to determine if IUI would be your best option.

If you along with the doctor feel that IUI is your best course to pursue, then they will start out with some basic tests which will include a transvaginal ultrasound on day 2 to 5 of your menstrual cycle to see the anatomy of the uterus as well as determine the number of follicles in each ovary.   They might do some blood tests for measuring hormonal levels and other parameters as well as an Anti Mullerian hormone (AMH) blood test for determining the total number of eggs in your ovaries.  They might do a hysterosalpingogram which is an Xray of the uterus and pelvis to see if the fallopian tubes are open.  Semen analysis will be done to determine the sperm count, morphology, motility and various other factors.  If everything looks okay then you can proceed with IUI.

They might then start you on some medication which can stimulate your ovaries to release more than one mature egg at one time and will monitor this progress through ultrasound.  So you might have to go for a scan routinely every few days to monitor the follicle size.  If you want to go the natural route, you will be going through the same process stated above without the aid of medications. Once the follicle has reached a specific size, you will be given a trigger shot which will cause you to ovulate in about 36 hours.

• What to expect during the procedure

Usually the IUI procedure will be planned on the day of your ovulation.  The semen sample will be taken from your partner or the sperm donor ( if a donor insemination has been planned) on this day.  It will be washed and concentrated in order to remove the seminal fluid and other debris and doesn’t irritate the uterus.  The procedure itself is very quick and typically painless and doesn’t need anesthesia.  You’ll lie on an exam table with stirrups and your doctor will use a speculum to gently open the vagina so that they can see your cervix.  The sperm will then be transferred through the cervix and placed into the uterus using a long, very thin tube.  This whole procedure will only take about 10 minutes and they might ask you to stay reclined on the table for 10 min following the procedure.  It is generally painless and done quickly.

• What to expect after the procedure

After your IUI procedure is completed, most women will hardly feel any discomfort but some may have some mild cramping and light spotting and this too is normal.  Some doctors may prescribe progesterone after the procedure and during the early stages of pregnancy whereas others may not.  There could be a small risk of infection following the IUI procedure although this is very rare.

After the procedure, you can go back to your regular activities because bed rest is not necessary.  However, you shouldn’t do any high intensity activities like strenuous exercise.  Continue taking prenatal vitamins including folic acid, eat a healthy diet and try to avoid stress.   In the days following an IUI procedure, you may feel overwhelmed or be anxious to find out the results.  So keep yourself busy by doing things that you enjoy like watching a good movie, going out with friends, reading a good book, listening to music, following a hobby or anything else.  Also, have a plan beforehand about what you will do if the results are negative so that this will not eat away at you during this waiting period.

You can take a pregnancy test two weeks after the IUI procedure. If you have any questions about this procedure or if you are unsure about what to do about infertility, please feel free to contact the experts at Xenith Advanced Fertility Centre .

IVF day is observed on July 25^th which is the birthdate of the first IVF baby named Louise Joy Brown born in 1978 on this day.  Since then the technology used for IVF treatment has grown in leaps and bounds.  Here are 5 common questions that are asked frequently.

1)What is IVF

In vitro fertilization (IVF) is a medical procedure used to help deal with infertility and aid in conception.  At the beginning of IVF procedure, the woman is given fertility medications to stimulate her ovaries in order to cause multiple eggs to mature at the same time.  She will be closely monitored during this time using blood tests and ultrasound scans.  When the eggs are finally matured, they are then retrieved under light anesthesia using a fine needle under ultrasound guidance.  The retrieved eggs are then fertilized with sperm that has already been cleaned and washed, in a culture medium in a laboratory.  The fertilized eggs develop into embryos and after 3 to 5 days, these embryos are transferred back into the woman’s womb or uterus for implantation.  Pregnancy is successful if the embryo attaches itself into the uterus lining or endometrium.  The mature eggs or the embryo can also be frozen and stored for future use.  The whole procedure can take anywhere from 4 to 7 weeks.

2)How successful is IVF

The IVF success rate is dependent on many factors like age, cause and duration of infertility, sperm and egg quality, as well as other health issues surrounding the patient.  One big factor is age and the success rate is higher in women under 35 and rapidly decreases after the age of 40 due to lower egg quantity and quality. Other health issues like weight, PCOS(polycystic ovary syndrome), diabetes and other disorders can affect conception.  Being obese has been shown to decrease the chances of success and thus following a good diet and getting enough exercise might improve the chances of conception.   An imbalance of hormones in women suffering from PCOS, can play havoc with the monthly reproductive cycles and this too could be rectified using proper diet, exercise and certain medications.  If the sperm is slow, a procedure called ICSI(intracytoplasmic sperm injection) could be used where the sperm is injected directly into the egg with a fine needle to aid in fertilization.  A technique called endometrial receptivity analysis could be used to study the endometrium in case of recurrent IVF implantation failure.  Laser assisted hatching is a procedure where a slight gap in the outer shell of the embryo is created to make it easier for the embryo to implant. A preimplantation genetic screening could also be done to look for any chromosomal abnormalities in the embryo before implantation.  Thus many challenges have been overcome to ensure a greater chance of success.  The success rate can also depend on the clinic you choose to undergo your IVF procedure and their success rate.  Does the clinic have the proper equipment and the expertise of the specialist for ensuring better chances of success?  By maintaining a healthy lifestyle, success rates could be optimized.  It is best to undergo a complete exam and consultation with your specialist to find out what is best for your unique circumstances.

3)Will IVF increase my chances of having twins or triplets

Statistically, there is  a slightly greater chance of multiple pregnancies in women undergoing IVF.  The main reason for this could be because more than one embryo might have been transferred back into the uterus for implantation to improve the odds of achieving a successful pregnancy.  So the number of embryos you want transferred needs to be discussed with your specialist.  Even though having twins when you are experiencing infertility might sound like good news, its best to aim for only one baby because there are risks involved with multiple births like preeclampsia, gestational diabetes, preterm delivery and low birth weight to name just a few risks on both mother and baby. 

4)Are there any side effects of IVF

IVF treatment is usually very safe but there can be some potential side effects. There may be hormonal effects like irritability, mood swings, depression, hot flashes, bloating, breast tenderness, nausea, and bruising at the injection sites.  Abdominal pain or slight cramping might be experienced after egg retrieval.  In very rare instances ovarian hyperstimulation syndrome(OHSS) might occur causing vomiting, nausea, shortness of breath, severe stomach pain. Xenith is an OHSS free clinic as patients are screened for this possibility before starting stimulation and selecting the right protocol to completely eliminate this risk.

Nowadays due to better treatment procedures, most patients experience no real pain throughout the treatment other than some bloating and in the end, this is well worth the trouble because you will be able to have a child that you have longed for.

5)Why is IVF so expensive

The cost of the IVF procedure can vary from couple to couple depending on the reason for the infertility, the various treatment procedures to be included along with IVF and the number of IVF cycles done in order to be successful in having a baby.  IVF treatment costs can vary from clinic to clinic due to the more technological equipment used and more highly qualified personnel.  The numerous ultrasound scans that need to be carried out and the various other tests like blood tests to monitor the follicle development can seem daunting.  There also might be the cost of donor eggs or sperm, freezing of the embryos or various other extra treatments that might be required like laser assisted hatching, ICSI where sperm is injected into the egg, or pre genetic screening of the embryo.  The numerous medications and hormonal injections can also be costly along with the single use disposables used in the lab for embryo formation.  Together all these costs can add up making IVF an expensive treatment. However, it is important to remember that conception in itself is a miraculous event and even when in vitro must be treated with the same care that it is in vivo. If you have further questions regarding IVF, feel free to contact us at Xenith Advanced Fertility Centre.

Most people are aware that being overweight could increase the risk of certain health problems like diabetes or heart disease.  Being overweight or being obese occurs when there is excessive fat accumulation that could be due to increased caloric consumption, changes in nutrition, inactivity, endocrine or hormonal disorders, psychological disorders or due to certain medications like steroids or antidepressants.  But did you know that being obese could also reduce fertility and decrease the chances of having a healthy baby?

What is considered the ideal weight

Body mass index (BMI) is an approximate measure of your total body fat and helps you figure out your optimum weight for good health.  It is calculated by dividing your weight (Kg) by your height squared (m²).  As per WHO guidelines, a healthy BMI is considered to be between 18.5 and 24.9.  However, having a BMI of 25-29.9 is considered overweight and a value over 30 is considered obese. (1) But your BMI isn’t always an accurate measure.  Your waist circumference can also be a good predictor of health risk because the distribution of fat on your body is more important than the total amount of fat. Having fat around your belly means you are more prone to develop certain health issues.  However, if you are muscular, it can also affect your BMI calculations because this calculation for BMI doesn’t differentiate between body fat and muscle mass.  So be aware that BMI is a general approximation of your health condition.  

How does excess weight affect fertility

In women, the menstrual cycle is regulated by a proper level of certain hormones.  This hormonal balance can be disrupted in obese women because they have higher levels of the hormone leptin which is produced in fatty tissue. The ovaries as well as fat cells both make the female hormone estrogen and too much estrogen and leptin due to increase in fat cells can lead to irregular or absent monthly cycles leading to infertility. Insulin resistance where the body produces more insulin in order to keep the blood sugar at normal levels can also be caused by having excess fat in the body which can in turn affect fertility.  Excess fat may also affect the ovaries, endometrium and quality of the eggs, leading to lower pregnancy rates and increased complications during pregnancy. In one study it was found that the risk of infertility is threefold higher in obese women than in women with a healthy weight and their fertility seems to be decreased in both natural and assisted conception cycles.(2)  Polycystic ovary syndrome (PCOS) which is a hormonal disorder affecting the ovaries is closely associated with obesity.  Obese women who are going through invitro fertilization (IVF) may also have decreased embryo quality, and they might need higher doses and longer period of ovarian stimulation.

Obesity in men can also be linked to decreased fertility.  It can affect the quality and the quantity of the sperm, lead to sexual dysfunction and other health conditions like diabetes and sleep apnea.

How to deal with obesity

The good news however is that even a modest weight loss of 5-10% can improve fertility. (3)  In other words, it is reversible leading to improved pregnancy outcomes.

Consult your doctor to find out if you are obese by having your height, weight and waist circumference recorded and ask them how to deal with obesity.  Meet with your doctor at regular intervals to monitor your progress.(4)

Improvements in diet and increased physical activity can tackle obesity. Try to lead a healthy lifestyle by eating a healthy diet, cutting out any junk foods like chips and fast foods, foods with refined sugars like cakes, biscuits and sweets, as well as fried foods.  Cut out smoking, drinking alcohol and try to reduce anything that causes you stress. Go outside for a walk for at least 30 minutes every day or go to the gym for a workout.  You could consult a dietician to help you evaluate your present diet and how it can be improved for your individualized needs.  You could turn to close friends, family, a therapist or join a support group who are dealing with the same issues as you to help and motivate you to lose weight.  It might also help to have your partner join you in this weight loss journey.  If these methods are unsuccessful, speak to your doctor about medications or surgery. If you have any questions about how your weight might be affecting your chances of getting pregnant, please feel free to come talk to the specialists at Xenith Advanced Fertility Centre and let them help you achieve your dreams of having children.

Maybe you and your partner have been trying to conceive but haven’t had “good news” for over a year? If you’re 35 or over, you may be more anxious than ever to start a family. Some couples may have experienced more than one miscarriage, and are still hoping for a pregnancy to reach full term. If that’s you, then you may need to move on to the next step of your journey which is to talk to a specialist in reproductive medicine and look for an infertility clinic to figure out what could possibly be delaying conception and pregnancy. 

With infertility clinics sprouting all over the city, which clinic to choose can seem like an arduous task especially with countless centers all making similar claims. It’s important to understand what to look for and do some thorough research as to which one is best suited for your needs before you pick the IVF clinic of your choice.

Is IVF treatment necessary?

IVF or in vitro fertilization is a procedure where the woman is first stimulated to ovulate using medications to produce more than one egg.  These eggs are then retrieved, combined with the washed sperm in a lab setting and the resulting embryo is then introduced back into the woman’s uterus for implantation in order to achieve a pregnancy.  Laser-assisted hatching is a procedure where a slight gap in the outer shell of the embryo is created to make it easier for the embryo to implant.  Any leftover eggs or embryos could be frozen or cryopreserved for future use. 

Keep in mind that not everyone who goes to an infertility clinic will need IVF treatment. The doctors will first perform a few fertility tests and then determine the course of treatment that you need. At Xenith, we do not believe in a one-size-fits-all approach. Each couple’s case is unique and we customize fertility treatment based on the results of your fertility tests. We begin with the first line of treatment and recommend couples to go through the IVF when indicated. With that said, couples looking for an infertility clinic should begin with ….

Research, research, research!

∙       Find out what kind of tests or procedures you may need to undergo for IVF.  What should you look for in the doctor’s qualifications?

∙       Give some thought to how far you are willing to go with this process.  Is there a time limit or the number of times you are willing to try the procedure?

∙       Infertility treatments can be expensive, because they may have to be done multiple times before the desired result is achieved.  How can you plan finances? 

∙      Medications and hormones that are used for treatment might cause some side effects, as well as the stress of going through this, could affect on your emotions.  Knowing more about this upfront can help you be more prepared to ask the right questions.

Once you know what you are looking for, then you can begin to search for a clinic that’s best suited for you.

What to look for in an infertility clinic?

Success rates can be dependent on various factors some of which include age, the reason for infertility, genetics, and lifestyle.  The success rate can be found on the clinic websites but it’s important to discuss this in person with the specialist. Having the highest success rate doesn’t necessarily mean that the clinic is the best.   Some clinics may refuse to take on difficult cases for women over 40 and this can make the statistics look better.   Success rates may not consider the number of miscarriages and just show the total number of conceptions.  It is prudent to ask specific questions like  how many gave birth successfully for your particular age group. 

Experience of doctors and clinical staff.  A good clinic should have a team of highly experienced professionals with specialization in infertility treatments.  A personal visit can help you get a feel for the clinic’s atmosphere. Look for a board-certified reproductive endocrinologist.  Find out how long they have been working and where they were trained.  Ask how many staff they have and the doctors associated with the clinic such as urologists, reproductive surgeons, nurses specifically trained in reproductive medicine, embryologist, sonographers, lab technicians, nutritionists, counselors, financial advisors, and others. 

First impressions count! Do the staff seem pleasant or are they in a hurry to have time for you?  Are you able to have a good rapport with the doctor? Is the doctor able to take the time to answer all your questions in a way that you can understand and make you feel that you are in confident hands?  Is there an emergency number? Would you be able to contact a qualified person when you need to?

Cost. What is the pricing for the various tests and treatments and what does this price include like medications, any extra procedures or monitoring, and embryo storage?  Will the cost be covered by your insurance?    How much does embryo freezing and storage cost?  Is counseling included in the cost? Costs may appear different at different places at times, but the quality management at an IVF clinic is a most important criteria which can vary between clinics. Pricing and value is not always the same thing.

Procedures and equipment. An infertility clinic that uses cutting-edge technology can provide you with every possible advantage for achieving success.  Find out where the procedures and tests are carried out.  An in-house lab can save you the inconvenience of having to make appointments in other diagnostic centers but they should be accredited and registered with the Appropriate Authority.

Customer ratings and reviews or testimonials. Speak to current or former patients or read about other patients’ experiences with that particular clinic. In the age of social media and digital era this can be a pointer, however it is important that you get your own feel about the doctor and the centre by visiting in person.  

Meeting a fertility specialist for the first time may be an intimidating experience and it might be awkward to talk about your personal details especially if you are already anxious and depressed about the idea of infertility.  At times it may be difficult to process the information given to you.  Take time to digest all the information, discuss it with your partner, and feel free to ask the same question again if you didn’t understand.  After looking at all the various options, make an informed choice about which IVF clinic works best for your unique circumstances.  Picking the right fertility clinic in Pune can help increase your chances of a successful conception and also make the whole journey a lot easier.  If you are looking for a clinic with extremely qualified fertility specialists and friendly staff wanting to make sure you are as comfortable as possible, feel free to schedule a consult at Xenith Advanced Fertility Centre, the top fertility specialists in Pune.

More and more women are open to plan their pregnancies. They may want to achieve their career goals, be financially stable, get married later in life, or have health issues.  Since the reservoir of eggs depletes in quantity and quality, as age advances, a woman may want to preserve good quality eggs for future pregnancy. Egg freezing is one of the methods to preserve one’s eggs at a younger age so that at a later date, these eggs can be used through in vitro fertilization (IVF) to have a baby.  

Here are 10 common questions that are often asked about egg freezing

1. At what age do you begin?

It is better to preserve your eggs before age of 35.  However, age can be just a number because no two women are the same and each person is unique with different health issues, genetic factors, or other problems.  One study has found that egg freezing has the largest benefit and is most cost effective before  age 37.  However, the highest probability of live birth was when egg freezing was done at ages of less than 34 years and there was little benefit if it was done between ages 25 to 30 years.¹      Having said that, the earlier the oocytes are frozen the better the quality of the oocytes.

• What does the whole procedure entail?

Initially the doctor will review your medical history, do a physical exam, run some blood tests and do a pelvic ultrasound in order to find out if the number of eggs you have is enough for egg freezing.  The treatment then is begun with medications and hormonal injections to stimulate egg growth and you might need to go to the clinic  for blood tests and ultrasounds in order for them to monitor how the eggs are growing and when to retrieve those eggs.  Once the eggs have matured, they are removed using a needle under guidance of ultrasound and done under anaesthesia. The procedure itself will take 15-30 minutes.  It is then cryogenically frozen immediately for future use.  The whole procedure will take approximately 2-3 weeks and is the same as the initial stages of IVF process.  When the patient is ready to try to become pregnant, the eggs are thawed, injected with a sperm to fertilize to form an embryo and then transferred to the uterus for implantation.

• Is fertility treatment safe?

Fertility treatment is quite safe with minimal risks. There might be some side effects from the medications like bloating, headache, and breast tenderness although these symptoms are usually reversible. You might feel slight cramping after waking up from the anaesthesia.

• How do they freeze the eggs?

The eggs are frozen in a matter of milliseconds, in a process called vitrification or fast freezing.  Eggs contain water and freezing them slowly leads to crystal formation which can in turn damage the egg.  With vitrification, it happens so fast that ice crystals cannot be formed.  In this process, water molecules are  replaced with a preserving solution before being flash frozen in liquid nitrogen at -196^oC in special cryogenic freezers.  At this low temperature, the biological process in the egg is halted so that it can be stored safely for later use.  In order to later thaw the egg, it must be warmed quickly and removed from the solution carefully.  The thawed egg is then fertilized with a sperm using IVF with intracytoplasmic sperm injection(ICSI) where a single sperm is injected directly into the egg.   ICSI is the preferred method because the freezing process hardens the eggs outer membrane.     

• How long can we keep the eggs? 

Theoretically, frozen eggs can be stored for a long time but this is governed by the laws in various countries.  In India, frozen eggs and their records can be kept for ten years. 

• Will I be using up my egg supply more by egg freezing?

Every month a group of follicles get ready to mature and become eggs.  However, only one egg will ovulate and the remaining ones never get used and degrade.  In the procedure of egg freezing these remaining eggs will also be rescued and removed for freezing.  You don’t use up more eggs than you normally would.

• How many eggs should you freeze?

There are many factors which can determine how many eggs to retrieve.  Generally, the more eggs you have, the better chances of getting pregnant.  But the chances of getting good quality and quantity of eggs also depends on the age when you freeze the eggs because egg quality and quantity declines with age. An older woman might need to freeze more eggs in order to have better chances of getting pregnant.  In one study, it was found that a woman under the age of 35 has about 85% chance of having a baby with 15 frozen eggs.² The number of eggs you freeze also depends on how many children you would want to have in the future. Talk to your doctor about what your chances would be for becoming pregnant.

• What is the cost of egg freezing?

The cost of egg freezing could be quite considerable and should include the cost of the freezing procedure itself as well as the yearly cost of maintaining the eggs in the frozen state.  The price can vary from clinic to clinic.  Some questions to ask if it’s included in the price package are: does it include doctors consultation fee, cost of anaesthesia and the procedure. Ask whether the cost include additional tests, if needed. Does the cost include medications and if medications are not included, how much would medications cost separately?  Make sure you fully understand what is included in the price breakdown so that you will not get a surprise charge later.

•  Is egg freezing safe for baby and mother?

Many babies have been born using this technology.  Studies showed no increased rate of birth defects compared to the general population.  They showed no increased rates of chromosomal or birth defects or pregnancy complications.

1. How long does it take to get your period back again after egg retrieval?

It usually takes 7-10 days after getting the injection that triggers ovulation for egg retrieval.  Then the periods will be back to normal.  Your fertility will not be decreased and this procedure will not cause you to go into early menopause. If you have any more questions about egg freezing and if you are contemplating egg freezing, please feel free to contact the fertility specialists in Pune at Xenith Advanced Fertility Centre.

For a sperm to fertilize an egg, the head of the sperm has to attach to the outside shell of the egg and push itself through to the inside of the egg called the cytoplasm where fertilization can finally take place.  Due to various reasons like a very thick outside shell of the egg or the sperm aren’t able to move as well, Intracytoplasmic Sperm Injection (ICSI) with IVF can be carried out to aid in fertilization.

What is Intracytoplasmic Sperm Injection (ICSI)?

Intracytoplasmic Sperm Injection (ICSI) is a procedure often done in conjunction with In Vitro Fertilization (IVF) treatment and it has literally brought in new life, especially for men dealing with severe infertility. In ICSI a single sperm is loaded in an injection needle and injected into a single mature oocyte. So instead of the sperm piercing the egg and reaching it’s cytoplasm, it is injected into the egg thus enabling fertilization to happen even with extremely few or non-motile but viable sperms.  

How is ICSI different from an IVF procedure?

In an IVF treatment, the egg is placed in a petri dish with lots of sperm after washing the semen sample  hoping that one of the sperm will enter the egg and fertilize it on its own in a lab setting. However, in ICSI, a single sperm is injected directly into the egg to further aid in fertilization.  Thus, it provides an opportunity for men with poor sperm quality to become a father.

When is ICSI recommended as a fertility treatment option?

• Men with severe male infertility issues- such as  very low sperm count,  very low motility (not much sperm movement), or morphology (abnormally shaped sperm).

• Azoospermia- no sperms in the semen sample, but when sperms can be obtained from the testis.

• Men who have had a vasectomy that is irreversible or if the duct through which the sperm passes is blocked.  The sperm will have to be surgically extracted from the testicles.

• Men who have erectile issues or men who are paralyzed

• If using frozen sperm which are not of good quality

• Couples who have gone through many failed IVF cycles due to very poor fertilization rates

• If preimplantation genetic testing has to be done to screen the embryo genetically. It is thought that the presence of other sperm around the embryo can affect the test results.

• If frozen eggs are being used, sometimes the eggs shell can become hardened making it harder for the sperm to penetrate.  ICSI can aid in this instance.

• If only a few eggs are available, each one should be given the best chance for fertilization.

The ICSI procedure

The IVF treatment and the ICSI is basically the same except for the difference in how the insemination occurs.

Stimulation: The woman will be given fertility medications to stimulate egg production and maturation so that more than one egg will mature.  She will be monitored closely during this time via ultrasound and blood tests to find out exactly when the eggs will become mature.                                      

Retrieval of Eggs and Sperm: When the eggs have matured, they will be retrieved using ultrasound and a fine needle for aspiration. At the same time, a semen sample also needs to be provided. The semen sample is then washed and the sperm are separated from the seminal fluid and the motile sperms are separated from the immotile ones. If indicated sperms are retrieved from the testis using microsurgical methods.

Insemination: Once the eggs and sperms are retrieved, the fertilization is done in a lab culture dish by injecting each mature egg with a single sperm, using a  ICSI microscope. The sperms which have a normal shape and are fast-moving are selected for insemination by a trained embryologist.

Embryo formation: The inseminated eggs are then placed in an incubator which provides the best environment for the eggs to fertilize and form embryos. After about 24 hours, the eggs start showing signs of fertilization and it is closely monitored by the embryologist. It takes almost 3-5 days for the development of embryos.  Note that not every inseminated egg will get fertilized even when the sperm itself is injected into the egg. 

Embryo Transfer: The fertilized embryo is then transferred back to the uterus for implantation via a thin, flexible needle.

How safe is ICSI?

When an egg is fertilized naturally in the womb, it’s basically the survival of the fittest and the healthiest and best sperm tend to fertilize the eggs. However, with ICSI, the normal looking and viable sperm is sperm is chosen and used for the insemination. ICSI may lead to a marginal increase in risk of birth defects compared to natural conceptions, although the chances of fertilization are greatly improved.  Sometimes genetic factors and the underlying causes of infertility can also affect successful pregnancy. Discuss the advantages and disadvantages of using ICSI for your specific circumstances with a fertility specialist.  Know your risks, any side effects, and what the whole procedure entails.  Speak to the IVF specialists at Xenith Advanced Fertility Centre if you would like more information about ICSI/IVF.

Folic acid is produced synthetically to mimic a naturally occurring B9 vitamin called folate.  It is an important component of a holistic nutrition for pregnancy program. Folate helps the body to make red blood cells and is also needed for healthy cell growth.  Folic acid along with Vitamin B12Vitamin B12 and vitamin C help the body with the breaking down, using, and creation of new proteins.  It also helps in DNA production which is the building block and carries the genetic information of your body. 

Because our body cannot make folate, we need to get it from our diet.  It is found in leafy vegetables like spinach, beets, beans, certain fruits like oranges, lemons, bananas and melons, nuts, eggs, and in certain animal organs like the liver and kidney.  The World Health Organization (WHO) recommends fortification of foods like flour with folic acid. 

Why is folic acid important for pregnancy?

To prevent anemia: Anemia is a condition where you don’t have enough healthy red blood cells to carry oxygen from the lungs to the rest of the body and folate aids in red blood cell production.  Pregnant women need to produce excess blood to provide nutrients for the baby.  Being anemic can cause the baby to be born with reduced birth weight or born premature.

For proper fetus development: The neural tube of the embryo develops into the brain and the spinal cord and for it to grow and develop properly, the proper amount of folic acid is needed.  Research shows that taking a daily folic acid supplement as recommended by your fertility doctor can support healthy growth of the baby. It is important to have proper folate levels in your body in the early stages after conception when the brain and spinal cord are developing and one should start taking folic acid supplements as early as 3 months before conception. 

Promotes full-term pregnancy: A full-term birth is considered to be 40 weeks and preterm or premature birth is if the baby is born in less than 37 weeks. 

Folic acid is water-soluble. It is excreted in the urine if it’s in excess and not used.  So, it needs to be taken daily. It is also recommended to take folic acid while you are breastfeeding the baby after you have already delivered the baby.  Talk to your doctor about any questions you might have about this and how much to take in your particular circumstances.  The specialists at Xenith Advanced Health Center are very knowledgeable in this or any other fertility or pregnancy-related questions.