Why does sperm count vary at every test? How can we determine the "real" sperm count ?

Even a normal (fertile) man's sperm count can vary considerably from week to week. Sperm count and motility can be affected by many factors, including time between ejaculations, illness, and medications. There are other factors which affect the sperm count as well, all of which we do not understand.

What is the difference between IVF and ICSI ?

IVF (In Vitro Fertilization) commonly known as test tube treatment, is a form of ART (Assisted Reproductive Technology). It essentially means taking the eggs outside the female body; fertilizing it with sperms inside a laboratory and then putting the embryo back into the womb. ICSI also falls under ART - a superior form of IVF which only differs in the method of fertilization. Here the fertilization is effectively achieved by injecting one single sperm into the egg using a microscopic needle.

What are the normal chances of pregnancy in a month ?

The most important factor reducing fertility in woman is increasing age, as women are born with all their oocytes (eggs). For a healthy, fertile couple in their 20s who have regular sex, the chance of conception each month is around 20%. For couples in their 30s, this drops to 10%.

What are the main side effects of IVF treatment ?
The side effects of fertility treatment can be:

Multiple Pregnancies

When more than one egg is fertilized and transferred into the uterus, the woman may give birth to twins, triplets, or even more number of babies. Multiple pregnancies often end in premature deliveries of babies who are not healthy enough to survive in this world. Nowadays, fetal reduction (i.e. destroying the extra embryos by pushing a salt solution under the guidance of ultrasonography, in early stages of pregnancy) is done to avoid the complications of multiple pregnancies.

Ovarian Hyper Stimulation Syndrome (OHSS)

It is caused when during ovulation induction with hormones, too many follicles start growing. In OHSS water, electrolyte and protein from the ovaries seep out through the blood vessels. The accumulation of fluid might cause pain and swelling in the abdomen, bloating sensation, swelling of leg, difficulty in respiration, nausea, vomiting, diarrhoea, weight gain etc. OHSS can be mild, moderate or severe depending on the symptoms. The treatment depends on the degree of OHSS, where the patient can be hospitalized, if required.

My internal examination shows I am normal. Do I still have to undergo tests to determine why
I am not conceiving ?

A routine gynecological examination does not provide information about possible problems which may cause infertility, such as blocked fallopian tubes or ovulatory disorders. You need a systematic infertility check up to figure out the cause of infertility.

My husband's blood group is B positive and I am A negative. Could this be a reason for our infertility ?

There is no relation between blood groups and fertility.

My husband has thick and voluminous semen. Does it mean he is normal ?

Semen consists mainly of seminal fluid, secreted by the seminal vesicles and the prostate. The volume and consistency of the semen is not related to its fertility potential. Fertility depends on the sperm count, which can only be assessed by microscopic examination.

Is there any surgery involved in IVF-ICSI ?

No surgery is involved in the procedures. With the help of transvaginal ultrasound, the eggs are taken out of the ovaries using a thin needle. Similarly, the sperms are also taken from the ejaculate with the help of a thin needle. In case of obstructive azoospermia, the sperms are taken from the epididymis or the testes, under local anaesthesia. This process is called PESA/TESA.

Is there any connection between sexual pleasure and fertility ?

There is no connection between sexual pleasure and fertility. Even a woman who gets raped can get pregnant. The commonest reason why women do not enjoy sex is because their husbands are unskilled lovers!

Is hospital stay necessary during IVF treatment ?

Medically hospital stay is not necessary during the treatment. But the patient has to visit the clinic 5 - 6 times during her treatment, which usually lasts for 6 weeks. However stay is advisable when the patient experiences any pain, abdominal discomfort or has to travel a long distance after embryo transfer.

I do not face any problem during sex. Since I am virile, is my sperm count normal as well ?

There is no correlation between male fertility and virility. Men with totally normal sex drives may have no sperms at all.

How important is age in fertility treatment ?

The age of the female partner is very important in fertility treatment. The quality of eggs and the capability of the endometrium to harbour the embryo go down with age. Best results are obtained for couples who are below 30 years. On the other hand if people continue to resort to treatments that don't have any scientific base, they would be losing out on their most important years of youth. Beyond which time even the best of treatments may not be effective. Thus the importance of age and adverse effects of advancing age on conception has to be fully understood.

Can painful periods be a cause for infertility ?

Painful periods are not a sign of infertility. In fact, regular painful periods usually indicate systematic ovulatory cycles. But progressively worsening pain during periods especially when accompanied by pain during sex may mean you have endometriosis.

After having sex, most of the semen leaks out of vagina. Can this cause infertility ?

Leakage of semen (which is called effluvium seminis) does not cause infertility. In fact, loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex.