Today, plenty of women are prioritizing their career and postponing marriage or family planning to their thirties. It is a known fact that as a woman gets older her fertility decreases and as a result of which, several couples face various complications while conceiving. These complications are on a steady rise in today’s modern world.

As we know, the most common and natural way to get pregnant is through intercourse with your partner without using birth control. One important part of getting pregnant for a woman is getting to know her body well, especially her monthly cycles. This can be assisted by various apps online which determine the important days for you to try to conceive. This information helps the couple as their chance of inducing pregnancy increases manifold during these days. According to a study, the couples who timed their intercourse with ovulation were more likely to get pregnant within three cycles as compared to the other couples.

If you are not able to conceive despite trying for a long time, it is advisable to seek a professional medical opinion. Early diagnosis of the problem helps solve the problem effectively within less time. Women younger than 35 who have not conceived after trying for a year should seek an appointment with a fertility expert. Similarly, women who are 35+ should consult a fertility expert after failing to conceive even after trying for a period of six months.

Infertility can be defined as the inability of a couple to conceive despite regular unprotected intercourse for a year or more. It is known to affect at least 10% of the couples across Unites States. Sometimes, it might also be due to unexplained causes. Science has made several medical advances which can help a couple conceive. Infertility needs to be diagnosed by a fertility expert before seeking an appropriate treatment for the same. Thanks to technology, infertility treatments have not only improved but also provide more options to choose from. Infertility can be treated by medication or a corrective surgery of the reproductive organs of the man or the woman suffering from it. Infertility treatments such as IVF and its adjunct procedures can help a woman conceive after a careful diagnosis of the underlying problem.

IVF (In Vitro Fertilization)

The most common and popular high technology method is IVF – In Vitro Fertilization. It was previously used to only help women who suffered from damage of fallopian tubes in their reproductive system. But today due to medical advances, it can be used to treat other types of infertility too.

In IVF treatment, the ovarian follicles are stimulated with super ovulation drugs over time. But the eggs are retrieved from the ovaries before their ovulation. Then they are fertilized with the sperm in a lab dish. IVF process usually requires a huge number of sperms in the range of fifty to ten thousands. The resulting embryo is implanted in the woman’s uterus. This process is called vitro-fertilization as the sperm fertilizes the egg in a “vitro” (meaning glass).

IVF cycle/treatment involves eight important steps.

1. Day one of menstrual cycle: This is counted as the first day of the IVF cycle. The medications are started before this day.

2. Ovary Stimulation: Hormones in the medications like FSH (Follicle Stimulating Hormone) or Luteinizing Hormone (LH) are used to stimulate the ovarian follicles to produce more eggs and nurture their growth.

3. Retrieval of Eggs: Eggs are retrieved from your ovaries. The average number of eggs collected would be 8-14. Your fertility specialist retrieves these eggs using the ultrasound technology to guide the needle to retrieve the eggs.

4. Sperm selection: A sample of fresh sperm will be taken from the male. The best and healthy sperm are selected for the procedure.

5. Vitro Fertilization: The eggs and sperm are placed in a dish and are given a chance to naturally fertilize and create an embryo.

6. Embryo Development: Once the embryo is formed it is stored in a special incubator where it can get nurtured.

7. Transferring the embryo: The embryo is placed in a small tube called the ‘catheter’ by a fertility expert so that the embryo is not disturbed at all. The catheter is then placed into the uterus through the cervix of the patient.

8. Final test: After a couple of weeks of the embryo transfer, a blood test of a patient is required to be done. This is done to gauge the levels of the hormone hCG (human chorionic gonadotropin) in the blood stream of the patient. The presence of hCG indicates that the pregnancy is induced.

Successful treatment of IVF depends on the availability of eggs which can be fertilized, active sperms and a womb which is able to support and nurture pregnancy

Frozen Embryo Transfer (FET)

During the IVF process, when a woman produces more high quality embryos than she wants to transfer, the remaining high quality embryos can be stored for further use. They are stored using freezing and thawing techniques. Research says that Frozen Embryo Transfer is becoming a popular and successful method on par with Fresh Embryo Transfer and in some cases women achieve even better success rate with Frozen Embryo Transfer. The benefit of Frozen Embryo Transfer is that no ovulation induction medicines or injections are used and there is no necessity to retrieve the eggs. This reduces the costs for the couple significantly.

The major drawback of FET is that not all embryos will survive the freezing and thawing and reach the stage of transfer into the uterus. In such a case, multiple embryos must be transferred to achieve some success at least but with a risk of multiple pregnancies.

Intracytoplasmic sperm injection (ICSI)

Sometimes IVF process fails despite good egg quality and even after following a correct procedure. It is known that the IVF process requires a huge number of sperms and they should be great swimmers and can actively fertilize the egg. But sometimes, it happens that

- The sperms have low motility or
- The sperm count is low or
- The sperm is infected with a high level of antibodies.

In any of the above cases, it is possibly the sperm quality which might be the root problem in an unsuccessful IVF procedure. The process of ICSI can be used in such cases. In fact, ICSI is usually recommended if any of the above cases is true.

In ICSI, a single sperm is retrieved and injected into each egg (oocyte). This process does not require a huge number of sperms like the IVF process. Also, the sperm does not need to penetrate the egg on its own now. It is injected directly into the egg and hence, the chances of fertilization have increased in comparison to conventional IVF.

In vitro maturation (IVM)

Sometimes a woman may not be able to conceive due to PCOS complications. Women with polycystic ovaries generally produce immature eggs in a single cycle. Earlier IVF could not be used to fertilize immature eggs and create an embryo. But now with the help of a process called IVM, this can be done too.

IVM can be used with conjunction to IVF. Earlier, these immature eggs were not usable for IVF. But thanks to science advancement, as a part of IVM, embryologists can retrieve these immature eggs surgically from the ovaries and “ripe” them in the lab. Eggs are placed in cell culture and stimulated with hormones until their maturity so that they can be used for IVF to carry out the further procedure. Sperm is then inserted in each egg using ICSI technique.

Therefore, in cases where conventional IVF is not possible, IVM can be suggested as an alternative method to induce pregnancy as an addition to IVF.

Intra Uterine Insemination (IUI)

Sometimes, a couple is unable to conceive due to one of the following reasons

- Low Sperm Count or Decreased Sperm Motility
- Ejaculation Dysfunction
- Hostile cervical Condition
- Unexplained Infertility

In such cases, a process called Intra Uterine Insemination (IUI) is recommended. It is a process which uses the most active and motile sperms from the man to inseminate the woman artificially.

Just like in IVF, in this process too, ovulation stimulating drugs are given to the patient and she is monitored closely to determine the timing of maturity of her eggs. IUI procedure is then performed at the time of ovulation.

Compared to IVF, the IUI process is more cost effective and much less invasive. But the success rate might not be as high as it is in the IVF procedure.

Suppose if IVF, all of the above adjunct procedures fail and the pregnancy is not induced, then a simple and safe method to get pregnant would be to seek help from potential and suitable egg donors or sperm donors. With their invaluable help of providing a gamete which can be fertilized it becomes easier to induce pregnancy in the woman. Also, if the woman doesn’t want to carry out the pregnancy by herself, she can always opt for a surrogate.