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Welcome to the youngest member of our family - the new, state-of-the-art Deccan Fertility Clinic and Keyhole Surgery Center. We have grown and in doing so we have multiplied our commitment to your dreams. As all younger siblings, Deccan has so many things that make it special. It is India's first budget IVF clinic, and the first of our tentative steps in taking the miracle of life to the masses. All men were born free and procreation shouldn't be a privilege. We hope to facilitate the transition to make it a medically-assisted right. We have been able to do this without compromising on our technology, techniques or our commitment to quality.
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Over the years, we have seen the look of joy on the faces of thousands of expecting parents who have belatedly experienced the miracle of life and we feel fortunate to have the privilege of spreading that joy a little further. Assisted Reproduction is an expensive proposition and we at Deccan are taking on the challenge of reaching out to the masses who need the treatment, even as they make difficult choices at home to aspire for it. We work towards the dream of making Assisted Reproduction a reality for the common man. We know that facing infertility can be one of the most stressful situations you may encounter, emotionally, physically and of course, financially. At the Deccan Fertility Clinic, we work hand-in-hand with you to make every phase of the process- from diagnosis to treatment- as predictable and comfortable as possible. Together we will map out a plan to determine the cause of your infertility and an appropriate course of action. Many problems can easily be corrected with medication or minimally invasive surgical procedures. For couples facing more difficult challenges, our ART program ranks among the best in the nation. We know when you visit our offices you may be worried about a procedure, a result, or your next step. Our staff is here to help - to answer all your questions, offer support, and make any procedures as comfortable as possible. Our goal is to provide our patients with state-of-the-art medical care and an environment that fosters the best possible outcome at affordable prices!!
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While the information provided here is not a substitute for the professional medical advice
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provided by your physician, it is a place to start as you search for a solution to overcome the challenge of infertility. We encourage you to learn as much as you can so you can make educated decisions about your options and find the support you need to get through this difficult and frustrating time in your life.
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FREQUENTLY ASKED QUESTIONS
What is Infertility? What is the incidence of infertility worldwide? My husband and I have an active sex life, we are both healthy, and my periods are regular. Why are we still unable to conceive? Is infertility exclusively a female problem?
In Vitro Fertilization (IVF) Intracytoplasmic Sperm Injection (ICSI) Success Rates Donor Egg IVF Overseas IVF Embryo Adoption Free Second Opinion DNA ID Check MYC Test
How can I determine my fertile period? What are the most common causes of infertility? My gynecologist has done an internal examination and said I am normal. Do I still need to get tests done to determine why I am not conceiving? What is the general progression of infertility treatment? Do painful periods cause infertility? What treatment options do infertile couples have?
One Day Training Course in Intrauterine Insemination One Year Fulltime Clinical Fellowship Program Hands-On Training Course in Gynecologic Endoscopy
My periods come only once every 6 week Could this be a reason for my infertility? How successful is infertility treatment? My husband's blood group is B positive and I am A negative. Could this blood group "incompatibility" be a reason for our infertility?
Round and About Muslim Views and Issues on ART ART Truths
Are there particular factors influencing the success of a treatment? After having sex, most of the semen leaks out of my vagina. How can we prevent this? Should we change our sexual technique? Could this be a reason for our infertility?
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What about success rates of IVF? My colleagues at work tell me that if we "work" hard at getting pregnant, and want it enough, we definitely will ! In fact, my mother in law is even suggesting that the fact that I am not conceiving means that subconsciously I do not wish to have a baby (because it may interfere with my career) and this psychological barrier is the reason for our infertility. Are there particular health risks for women undergoing infertility treatment? My grandmother says that if I just pray and have faith, I will definitely conceive. How far is this true? What is Ovarian Hyper Stimulation Syndrome(OHSS)?
Diagnostic Laparoscopy Operative Laparoscopy Laparoscopy FAQs Diagnostic Hysteroscopy Operative Hysteroscopy Hysteroscopy FAQs Our Publications BLOG
Gender selection is illegal in India. We do not advocate it nor do it.
My husband refuses to get his semen tested. He says the fact that it is thick and voluminous means it must be normal. Is that true? How do multiple births occur? My sister conceived only after 6 years of marriage. Does this mean I will also have difficulty conceiving? What are the common local side effects? My doctor just did a physical examination for me, and he feels that the reason for my infertility is that my uterus is tipped backwards, and this prevents the sperm from swimming into the uterus. He is advising I have surgery to correct this problem. Should I go ahead? Can ovulation induction increase the risk of ovarian cancer? My husband says we should be having intercourse every day to achieve pregnancy. Is this true? What about the health risks for children born following infertility treatment? My friends say I should have sex exactly on the day I ovulate to get pregnant. How can I do this? How important is counseling to the patient undergoing infertility treatment? My sister in law is advising me to keep a pillow under my hips during and after intercourse. Will this increase my chances of conceiving? What is the duration of one IVF or ICSI cycle? My mother feels I am too tense, and that if I just relax, I'll get pregnant. Is that true? What is Extra Uterine Pregnancy (EUP)?
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I just had a HSG (X-ray of the uterus and tubes) done, and this shows my tubes are blocked. I've never had symptoms of a pelvic infection, so how could my tubes get blocked? What is timed sexual intercourse? My doctor has advised me to take fertility drugs . I don't want to take them because I am scared that if I do , then I'll have a multiple birth. What is Egg donation? My husband's sperm count varies every time we test it! How do we determine what the "real" sperm count is? What is PCOS? I have no problems having sex. Since I am virile, is my sperm count normal? What is Embryo Reduction? I don't think infertility treatment should not offered in India, because there are too many babies in this country already. Why should we exacerbate the population problem by producing more? In any case, IVF treatment is too expensive for India to be able to afford it. What is Cryopreservation? My semen analysis report shows I have no sperm in the semen (azoospermia). Is this because I used to masturbate excessively as a boy? Is Intra Uterine Insemination suitable for every infertile couple? My wife is frigid and does not enjoy having sex. Could this be the reason for her infertility? What is TESE or MESA? What are the causes of damaged fallopian tubes? What is Cystic Fibrosis and Male Infertility? What is Endometriosis? What does Sperm Preparation mean? What is Reproductive Surgery? What does Laparoscopy involve? What is Infertility? Infertility, whether male or female, can be defined as 'the inability of a couple to achieve
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conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse'.
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What is the incidence of infertility worldwide? The World Health Organization (WHO) estimates that approximately 8-10% of couples experience some form of infertility problem. On a worldwide scale, this means that 50-80 million people suffer from infertility. However, the incidence of infertility may vary from region to region. In France, 18% of couples of childbearing age said that they had difficulties in conceiving.
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My husband and I have an active sex life, we are both healthy, and my periods are regular. Why are we still unable to conceive? You need to remember that it's not possible to determine the reason for your infertility until you undergo tests to find out if your husband's sperm count is normal; if your fallopian tubes and uterus are normal; and if you are producing eggs. Only after undergoing these tests will your doctor be able to tell you why you are not conceiving. While testing does cause considerable anxiety, it's far better to intelligently identify the problem so that we can look for the best solution.
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Is infertility exclusively a female problem? No. The incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 10-30% of the cases. Problems common to both partners are diagnosed in 15-30% of infertile couples. After thorough medical investigations, the causes of the fertility problem remain unexplained in only a minority of infertile couples (5-10%).
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How can I determine my fertile period? Your fertile period is the time during which having sex could lead to a pregnancy. This is the 46 days prior to ovulation (release of a mature egg from the ovary). Women normally ovulate 14 days prior to the date of the next menstrual period.
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What are the most common causes of infertility? The most common causes of female infertility are ovulatory disorders and anatomical abnormalities such as damaged fallopian tubes. Less frequent causes include, for example, endometriosis and hyperprolactinemia. Causes of male infertility can be divided into three main categories: Sperm production disorders affecting the quality and/or the quantity of sperm; anatomical obstructions; Other factors such immunological disorders. Approximately a third of all cases of male infertility can be attributed to immune or endocrine problems, as well as to a failure of the testes to respond to the hormonal stimulation triggering sperm production. However, in a great number of cases of male infertility due to inadequate spermatogenesis (sperm production) or sperm defects, the origin of the problem still remains unexplained.
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My gynecologist has done an internal examination and said I am normal. Do I still need to get tests done to determine why I am not conceiving? A routine gynecological examination does not provide information about possible problems which can cause infertility, such as blocked fallopian tubes or ovulatory disorders. You need a systematic infertility workup.
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What is the general progression of infertility treatment? A variety of procedures can be used to diagnose the cause of infertility in a couple; these range from simple blood tests to more complicated analytical methods. In any case, diagnosis is a crucial first step to determine the appropriate therapeutic path that should be followed. In addition to the cause itself, other factors, such as the age of the woman, or problems shared by both partners, might also influence the choice of treatment.
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Do painful periods cause infertility? Painful periods do not affect fertility. In fact, for most patients, regular painful periods usually signal ovulatory cycles. However, progressively worsening pain during periods (especially when this is accompanied by pain during sex) may mean you have endometriosis.
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What treatment options do infertile couples have? Several options are offered to couples depending on the type of infertility that has been diagnosed. The vast majority of female patients are successfully treated with the administration of drugs such as clomiphene citrate, cabergoline, metformin or gonadotropins. Surgery can also be a means to repair damage to the reproductive organs, such as those caused by endometriosis and infectious diseases. Treatment options for male infertility also include the administration of drugs, surgery and assisted reproductive technologies, such as intracytoplasmic sperm injection (ICSI). Drug therapy and surgery have proved very successful for specific types of male infertility. However, in a great number of cases, the reason why men have fertility problems remains unexplained and the treatment methods applied are empirical. Some patients nevertheless require more complex medical intervention. Assisted reproductive technologies (ART) refer to several different methods designed to overcome barriers to natural fertilization such as anatomical problems (eg blocked fallopian tubes). One of these techniques, in-vitro fertilization (IVF), has now been practiced for more than 15 years. Overall, the estimated number of infertile patients currently treated by ART is around 20%.
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My periods come only once every 6 week. Could this be a reason for my infertility? As long as the periods are regular, this means ovulation is occurring. Some normal women have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles every year, the number of times they are ‘fertile’ in a year is decreased. Also, they need to monitor their fertile period more closely, since this is delayed (as compared to women with a
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30 day cycle).
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How successful is infertility treatment? When talking of success rates for any type of infertility treatment, one should bear in mind that the average chance to conceive for a normally fertile couple having regular unprotected intercourse is around 25% during each menstrual cycle. It is estimated that 10% of normally fertile couples fail to conceive within their first year of attempt and 5% after two years. Comparable to normal fertility rates, effective treatments can be expected to have, on an average, up to a 25% success rate per cycle of treatment, and may therefore need to be repeated several times before a pregnancy is achieved. Simple ovulation induction to compensate for hormonal imbalances has a very high success rate; more than 80% of women suffering from such disorders are likely to conceive after several cycles of treatment with drugs such as clomiphene citrate or gonadotropins.
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My husband's blood group is B positive and I am A negative. Could this blood group 'incompatibility' be a reason for our infertility? There is no relation between blood groups and fertility.
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Are there particular factors influencing the success of a treatment? In any type of infertility treatment, important factors need to be taken into account when referring to success rates. The age of the woman and the duration of the couple's infertility are likely to influence the success of treatment. In women, fecundity decreases as age increases, particularly after 40 years of age. When the woman is being treated, her chances of conceiving can be lessened if her partner also has infertility problems (eg poor quality sperm).
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After having sex, most of the semen leaks out of my vagina. How can we prevent this? Should we change our sexual technique? Could this be a reason for our infertility? Loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex. Many infertile couples imagine that this is the cause of their problem. If your husband ejaculates inside you, then you can be sure that no matter how much semen leaks out afterwards, enough sperm will reach the cervical mucus. This leakage of semen (which is called effluvium seminis) is not a cause of infertility. In fact, this leakage is a good sign - it means your husband is depositing his semen normally in your vagina! Of course, you cannot see what goes in - you can only see what leaks out - but the fact that some is leaking out means enough is going in!
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What about success rates of IVF?
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Overall, success rates for IVF have steadily improved over the last ten years. Birth rates for IVF vary according to the expertise of the centers practicing this technique. However, centers in Europe have reported pregnancy rates after one cycle of IVF equal or superior to 25%. In 1993, the French IVF registry (FIVNAT) reported a pregnancy rate of 25.4% per embryo transfer on a total of 23,025 oocytes retrieved. Based on such results, after three to four cycles of IVF, a woman under 40 whose partner does not have any fertility problems could reasonably expect to give birth. Again, in general, success rates may vary from one center to another, since they are influenced not only by the level of expertise of the medical team but also by the characteristics of the patients treated. A clinic treating a large number of women over 40 is likely to report lower success rates than a clinic having a majority of patients under 35.
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My colleagues at work tell me that if we 'work' hard at getting pregnant, and want it enough, we definitely will! In fact, my mother in law is even suggesting that the fact that I am not conceiving means that subconsciously I do not wish to have a baby (because it may interfere with my career) and this psychological barrier is the reason for our infertility. Unlike many other parts of your lives, infertility may be beyond your control. Don't blame yourself if you are not getting pregnant - it's a medical problem which often needs appropriate medical treatment. The attitudes you are encountering are often born out of ignorance - and are a kind of ‘victim-blaming’ - ignore them!
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Are there particular health risks for women undergoing infertility treatment? Along with their intended benefits, drugs used to treat infertility may on occasion cause side effects. In ovulation induction, close monitoring of follicular growth is crucial to ensuring successful treatment. Monitoring techniques (such as ultrasound scan and blood tests) and adequate use of treatment protocols help the physician to avoid ovarian hyperstimulation syndrome (OHSS) and minimize the risk of multiple pregnancy. Current treatment protocols have been designed to reduce the risk of multiple births and OHSS.
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My grandmother says that if I just pray and have faith, I will definitely conceive. How far is this true? Believing in god can help you to maintain a positive outlook - but sheer will and blind faith won't overcome a physical problem like blocked tubes or absent sperms.
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What is Ovarian Hyper Stimulation Syndrome (OHSS)? Ovarian Hyper Stimulation Syndrome (OHSS) is a side-effect that can occur during infertility treatment with ovulation inducing drugs. Symptoms of this syndrome may include ovarian enlargement, accumulation of fluid in the abdomen and gastrointestinal disorders (nausea, vomiting, diarrhea). Severe cases of OHSS are however very rare (1-2% of cases).
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My husband refuses to get his semen tested. He says the fact that it is thick and voluminous means it must be normal. Is that true? 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, which depends upon the sperm count. This can only be assessed by microscopic examination.
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How do multiple births occur? Multiple births occur more frequently after infertility treatment than in the normal population. About 80% of pregnancies achieved following simple ovulation induction with gonadotropins result in single births, the remaining 20% being multiple pregnancies, mostly twin pregnancies. New treatment regimens carefully adapted to the patient's response help to decrease the risk of a multiple pregnancy. After IVF, one pregnancy out of four is multiple (20% twin pregnancies and 3-4% triplets). In IVF centers, physicians now frequently choose to replace a maximum of three embryos after fertilization, to further reduce the chance of multiple births.
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My sister conceived only after 6 years of marriage. Does this mean I will also have difficulty conceiving? If your mother, grandmother or sister has had difficulty becoming pregnant, this does not necessarily mean you will have the same problem! Most infertility problems are not hereditary, and you need a complete evaluation.
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What are the common local side effects? Common local side effects experienced by patients who receive gonadotropins by intramuscular injection include skin redness, swelling and bruising. Pain and discomfort sometimes reported after intramuscular injections are now likely to be lessened with the availability of gonadotropins produced by recombinant DNA - or genetic engineeringtechniques, which are administered by subcutaneous injection.
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My doctor just did a physical examination for me, and he feels that the reason for my infertility is that my uterus is tipped backwards, and this prevents the sperm from swimming into the uterus. He is advising I have surgery to correct this problem. Should I go ahead? About one in five women will have a retroverted uterus. If the uterus is freely mobile, this is normal, and is not a cause of infertility. This is not an indication for surgery!
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Can ovulation induction increase the risk of ovarian cancer? Ovarian cancer is a rare disease; the chance of a young woman developing an ovarian malignancy during her lifetime is lower than 1.5%. A number of factors have been found to increase the risk of ovarian cancer, including genetic predisposition and dietary habits. Scientific studies carried out in the last few decades have demonstrated that infertility itself is a risk factor for ovarian cancer. There is evidence that each pregnancy reduces the risk of a woman contracting ovarian cancer (this risk could be reduced by more than 25% by a first pregnancy). No epidemiological study has ever established a causal link between ovulation promoting drugs and ovarian cancer. An extensive study on this issue, reporting on more than 2,600 women treated between 1964 and 1974 and followed for an average of twelve years, found no association between ovulation inducing drugs and ovarian cancer.
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My husband says we should be having intercourse every day to achieve pregnancy. Is this true? Sperm remain alive and active in woman's cervical mucus for 48-72 hours following sexual intercourse; therefore, it isn't necessary to plan your lovemaking on a rigid schedule.
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What about the health risks for children born following infertility treatment? Regarding children born following treatment with ovulation promoting drugs, the incidence of birth defects has never been found to be higher than that in the normal population.
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My friends say I should have sex exactly on the day I ovulate to get pregnant. How can I do this? Although having sexual intercourse near the time of ovulation is important, no single day is critical. So, don't be concerned if intercourse is not possible or practical on the day of ovulation.
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How important is counseling to the patient undergoing infertility treatment? The physician helps the infertile couple find the most appropriate therapeutic path to overcome barriers to conception, but, before a treatment is started, patients need to be aware of all its aspects, including its constraints. Beyond the medical expertise, infertile couples are also looking for counseling and support. From a psychological point of view, infertility is often a hard condition to cope with. During treatment and before a pregnancy is achieved, feelings of frustration or loss of control usually experienced by the infertile couple are likely to be exacerbated. Management of infertility includes both the physical and emotional care of the couple. Therefore, support from physicians, nurses and all people involved in treating the infertile couple is essential to help them cope with the various aspects of their condition. Offering counseling and contact with other infertile couples and patient associations can provide help outside the medical environment.
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My sister-in-law is advising me to keep a pillow under my hips during and after intercourse. Will this increase my chances of conceiving? Sperm are already swimming in cervical mucus as sexual intercourse is completed and will continue to travel up the cervix to the fallopian tube for the next 48 to 72 hours. The position of the hips really doesn't matter.
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What is the duration of one IVF or ICSI cycle? One complete IVF or ICSI cycle takes approximately 15 to 16 days. From Day 1 or 2 of menses the stimulation of the ovaries start by muscular or subcutaneous injections of hormones. The mean stimulation period is 12 days, depending on the reaction of the ovaries. The ovum pick up takes place within two days after stopping the stimulation (usually on day 13). Now the real IVF or ICSI follows in the laboratory. When fertilization occurs, embryos are transferred into the uterus (usually on day 15) and drugs supporting the uterus are given. After approximately 13 days a pregnancy test will show whether the IVF treatment has been successful or not.
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My mother feels I am too tense, and that if I just relax, I'll get pregnant. Is that true? If pregnancy has not occurred after a year, chances are there is a medical condition causing infertility. There is no evidence that stress causes infertility. Remember, all infertile patients are under stress- it's not the stress which causes infertility, it's the infertility which causes the stress!
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What is Extra Uterine Pregnancy (EUP)? When a pregnancy is not located in the uterus it is called an Extra Uterine Pregnancy (EUP) or ectopic pregnancy. The most common place for an EUP is the fallopian tube but sometimes the ectopic pregnancy is located elsewhere, such as in the cervix, the ovary or in the abdomen. EUP is a rare disease and occurs in 1% of all pregnancies. With IVF treatment the risk can increase. Risk factors for EUP are a history of infection of the tubes (salpingitis), chlamydia infection, Pelvic Inflammatory Disease (PID), former EUP, operation on the tubes or in the lower abdomen, endometriosis and appendicitis. The symptoms of ectopic pregnancy are often similar to those of a normal miscarriage and may include a positive pregnancy test together with or without vaginal bleeding and abdominal pain. Although it is not common, the possibility of EUP has to be considered in patients with the symptoms and one (or more) of the risk factors for EUP. Diagnosis is made by questioning the patient on the risk factors, physical examination, vaginal ultrasound and laboratory findings. Depending on the size and the location of the EUP, different treatments can be given. Mostly the ectopic pregnancy will be removed surgically but occasionally medical treatment or expectant treatment is offered when the pregnancy is very small and thorough control of the patient is possible.
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I just had a HSG (X-ray of the uterus and tubes) done, and this shows my tubes are blocked. I've never had symptoms of a pelvic infection, so how could my tubes get blocked? Many pelvic infections have no symptoms at all, but can cause damage, sometimes irreversibly, to the tubes.
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What is timed sexual intercourse? To increase the chance of getting pregnant spontaneously, timed sexual intercourse is recommended. This means that sexual intercourse, or coitus, has to be taken place around the time of ovulation, which is the most fertile period of a woman. To detect the approximate time of ovulation a temperature curve of several menstrual cycles can be made. The woman takes her body temperature each morning before getting out of bed, starting on the first day of the menstruation until the start of a new period. The body temperature rises around 0.5 degree Celsius after the ovulation. This is mostly about 14 days after the first day of the period and when no pregnancy occurs the temperature drops to normal again; with pregnancy the temperature stays high. One can also use urine or saliva tests to detect the ovulation. The time of ovulation can sometimes vary a few days each month, even in a regular menstrual cycle. Also, if the circumstances are right, sperm can live inside the women for a few days and sperm quality can decrease with high sexual activity. Therefore it is best to have intercourse 34 days before the expected ovulation and every other day until 2-3 days after the expected ovulation with no necessity for higher frequency. When tests are used to detect ovulation it is advised to have sexual intercourse on the day of a positive test.
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My doctor has advised me to take fertility drugs. I don't want to take them because I am scared that if I do, then I'll have a multiple birth. Although fertility drugs do increase the chance of having a multiple pregnancy (because they stimulate the ovaries to produce several eggs) the majority of women taking them have singleton births.
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What is Egg Donation? Women with no or not properly working ovaries can, in some cases, get pregnant through egg donation. In this procedure another woman will be the egg donor. This woman will have an IVF stimulation and ovum pick-up. After the ovum pick-up the collected eggs will be fertilized with sperm of the partner of the recipient woman ie donor acceptor. The embryos are then transferred into the uterus of the recipient. If a pregnancy occurs the recipient and her partner will have a child which is biologically only half their own.
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My husband's sperm count varies every time we test it! How do we determine what
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the 'real' sperm count is? 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.
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What is PCOS? Poly Cystic Ovary Syndrome or PCOS is an ovulation disorder, which affects 4-6% of all women. Several factors contribute to the disease. At this moment researchers think that the cause of the disease is genetic. The major features of this syndrome are irregular or no menstruation, hirsutism and acne due to high levels of male hormones, obesity (40-50%), high insulin levels with risk of developing diabetes and large polycystic ovaries shown on ultrasound. Women with PCOS usually present at fertility clinics for counseling. To increase fecundity the treatment possibilities are mostly focused on regulation of the menstrual cycle. For this, several drugs are used (clomiphene citrate, metformin, gonadotropins) and weight loss is strongly advised. In many cases the cycle will be ovulatory and regulated by these treatments. Furthermore at this moment it is being investigated whether electrocoagulation of the large ovaries can give (long-term) regulation of the cycles.
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I have no problems having sex. Since I am virile, is my sperm count normal? There is no correlation between male fertility and virility. Men with totally normal sex drives may have no sperms at all.
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What is Embryo Reduction? Assisted Reproductive Therapy (ART) has caused an increase in multiple pregnancies. This situation is especially seen in ovulation induction and Intra Uterine Insemination. In order to prevent the risk of severe premature birth and handicaps as well as risks for the mother, embryo reduction is sometimes performed. The number of embryos in the uterus is reduced and the remaining pregnancy has a better chance of normal development and delivery. Of course this is not an easy decision for either the patients or the doctor. With careful guidance of the patient during treatment and good counseling when the patient is at risk for a large multiple pregnancy, many triplets or higher order pregnancies may be avoided.
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I don't think infertility treatment should be offered in India, because there are too many babies in this country already. Why should we exacerbate the population problem by producing more? In any case, IVF treatment is too expensive for India to be able to afford it. The right to have children is a fundamental right of every human being and a very basic biological urge. Just because a neighbor has too many children should not deprive the infertile
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couple of their right to have their own. IVF and related technologies are undoubtedly expensive, but, then, so is heart surgery. Yet, no one objects when over Rs 1 lakh are spent to try to salvage the heart of a 70-year-old man (whose life expectancy in any case is only about 5 years and is not extended by the surgery). Why then should medical technology not be used to help couples in their thirties (with their whole lives ahead of them) have their own baby? In fact, IVF is a much more cost-effective use of medical resources than a number of other accepted surgical procedures (such as joint replacement surgery or kidney transplants).
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What is Cryopreservation? Cryopreservation means preserving in a frozen condition. The best known cryopreservation is of semen. This is mostly done in case of cancer of the testicles before treatment of the cancer. Furthermore cryopreserved semen is used in donor insemination. It is also possible to freeze fertilized eggs after IVF or ICSI. If more embryos are left after an IVF or ICSI procedure they can be frozen and transferred another time. In this way there is another chance of a pregnancy while only one IVF or ICSI cycle is performed. For human oocytes cryopreservation is much more difficult. Only in very few experiments this is done successfully. The attention of researchers now is on developing a way to freeze ovarian tissue and after thawing, to obtain the oocytes in it. This procedure is not yet fully refined but when it is it can offer great opportunities in the future.
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My semen analysis report shows I have no sperm in the semen (azoospermia). Is this because I used to masturbate excessively as a boy? Masturbation is a normal activity which most boys and men indulge in. It does not affect the sperm count. You cannot ‘run’ out of sperms, because these are constantly being produced in the testes.
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Is Intra Uterine Insemination suitable for every infertile couple? No. In Intra Uterine Insemination (IUI) processed semen is directly put into the uterus. It is a technique used for couples with fertility problems based on specific causes. These causes are Cervical hostility: This means that the cervix is not permeable for semen shown after the Post Coital Test.
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Idiopathic subfertility: No cause has been found for the inability to conceive Male subfertility The sperm quality is decreased. Clinics use different ranges for sperm count in which they perform IUI.
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Sperm Antibodies: Inability for vaginal ejaculation with decreased sperm quality For example in men with retrograde ejaculation or spinal cord injury.
IUI can be performed either in a spontaneous ovulatory cycle (cervical hostility) or in a cycle with ovarian stimulating hormones (idiopathic subfertility and male subfertility/sperm
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antibodies). The stimulation is mostly done with clomiphene citrate or gonadotropins.
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My wife is frigid and does not enjoy having sex. Could this be the reason for her infertility? There is no connection between sexual pleasure and fertility. Don't forget that even a woman who gets raped can get pregnant! And don't forget that the commonest reason women do not enjoy sex is because their husbands are unskilled lovers! Maybe you should improve your sexual technique, and spend more time in foreplay and in pleasuring your wife!
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What is TESE or MESA? TESE (Testicular Sperm Extraction): Sperm collected out of the testicles after operation. MESA (Microsurgical Epididymal Sperm Aspiration): Sperm collected out of the epididymis after operation.TESE or MESA is a technique developed for patients with no sperm cells in their sperm due to an undeveloped or obstructed spermatic cord. The cause of obstruction can be a former sterilization or an infection of the epididymis. When the testicles make no sperm cells at all, of course TESE or MESA is not possible. If sperm cells are obtained, an ICSI procedure (Intra Cytoplasmic Sperm Injection) will follow. ICSI is like IVF; only now one sperm cell is injected into each egg to fertilize it and make an embryo.
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What are the causes of damaged fallopian tubes? In the beginning In Vitro Fertilization (IVF) was developed for patients facing infertility due to damaged fallopian tubes. Later on the indications to perform IVF were broadened, for example, unexplained infertility and male infertility. Nowadays tubal damage still accounts for a large number of all IVF treatments. The main cause is abdominal infection. This is mostly due to sexually transmitted diseases (for example chlamydia or gonorrhea) but complicated appendicitis or Pelvic Inflammatory Disease (PID) can also cause damaged tubes. Other causes are abdominal operations (gynecological operations, Cesarean section, sterilization or other) and internal diseases like Crohn's disease. Affected patients can have fertility problems and are at risk for having a pregnancy located in the tubes (ectopic or tubal pregnancy).
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What is Cystic Fibrosis and Male Infertility? Men who have cystic fibrosis often have a congenital anomaly in the male genital tract. The vas deferens, the tube connecting the testicle and epididymis to the ejaculatory duct, is congenitally absent. This makes it impossible for the sperms to pass through the penis. Using testicular sperm aspiration, the urologist can obtain sufficient sperm to allow excellent success with IVF and ICSI (intra cytoplasmic sperm injection). Insufficient numbers of sperm are obtained to make intrauterine insemination an effective option. As cystic fibrosis is a recessive genetic disorder, abnormal gene contributions from both parents are necessary for this disorder to be present. Both copies of the gene are abnormal in men with CF. While persons carrying a single copy of an abnormal gene do not have this condition, when paired with a
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partner with CF, they have a 50% chance of CF in their offspring. This makes testing the female partner advisable. If the woman tests normal, the children will be carriers for an abnormal gene and although they will not likely have CF, it is advised that their spouses be checked for CF gene abnormalities.
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What is Endometriosis? Tissue histologically identical to the endometrium (the inner lining of the uterine wall) outside the uterine cavity. Usually, endometriosis is confined to the pelvic and lower abdominal cavity; however, it has occasionally been reported in other areas as well. Endometriosis is one of the most common problems that gynecologists currently face. It is one of the most complex and least understood diseases in our field and, despite many theories, we still do not have a clear understanding of the cause or of its relationship to infertility. Since this disorder is primarily a human disease and rare in other animal species, accumulation of the facts has been slow. Although endometriosis has been considered a pathological or separate disease entity, it may not be a disease at all. It may actually be the clinical manifestation of a more basic underlying disorder, such as a basic chemical or physiological abnormality that affects the tubal motility or immune system which could be responsible for the initiation or progression of endometriosis in patients with retrograde menstrual flow. By the same token, endometriosis may not be the cause of infertility, but the result of it. Further technological developments may be necessary in order for us to fully understand this problem.
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What does Sperm Preparation mean? Spermatozoa are ejaculated in the seminal fluid during intercourse or masturbation. During assisted reproduction the spermatozoa are extracted from the semen by a series of processes - centrifugation and washing, layering (to select the active sperm and leave the immotile or dead sperm behind) or selecting the best sperm by making them swim through a denser medium and using those that succeed.
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What is Reproductive Surgery? Reproductive surgery is a subspecialty that treats anatomical abnormalities interfering with normal reproductive function. Advanced reproductive surgery requires meticulous surgical technique for optimal results, including rapid patient recovery and avoiding the need for routine hospitalization. Reproductive surgeons treat tubal obstruction, endometriosis, uterine fibroids, scarring of the ovaries or other pelvic structures resulting from pelvic inflammatory disease (PID) in the female, and varicocele and vas obstruction in the male as well as other abnormalities.
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What does Laparoscopy involve? The laparoscope allows visual inspection of the pelvic organs through a very tiny incision. Abnormalities that lead to infertility can be treated surgically through additional small incisions
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to remove scar tissue, laser, coagulate, or excise endometriosis, and repair tubes blocked at the fimbrial end. Many types of female reproductive surgery can be performed laparoscopically in the outpatient setting.
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CONTACT US
Deccan Fertility Clinic & Keyhole Surgery Center 1, Shankar Niwas, Plot No 117, Dadasaheb Rege Marg, Opp Shiv Sena Bhavan, Shivaji Park, Mumbai 400 028 India Tel: +91 22 2446 6633 / 2444 9992 Fax: +91 22 2444 4443 Email:deccanivf@gmail.com To Fill Online Feedback Form, click here (Please disable anti popup software before)
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PROFILE
The Deccan Fertility Clinic provides comprehensive IVF services, all under one roof, so patients don't need to shuttle from clinic to lab to the scan center. Our practice is restricted to treating infertile patients exclusively, and we offer our patients the very best medical care - at affordable prices.
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At the Deccan Fertility Clinic, we recognize the importance of the healthcare team functioning as a coordinated unit in the overall treatment plan. Each member of the Deccan staff, from the physicians to the nursing coordinator, plays a critical role in providing the high-level of reproductive healthcare that our patients have come to expect from the Rotunda group. We acknowledge the skills and contributions of each team member and support education, outreach and research to enhance our staff's knowledge and further the field of reproductive healthcare. The team is led by the Medical Director, Dr Gautam N Allahbadia who coordinates the Infertility & Assisted Conception services along with the Clinical Associate, Dr Sulbha Arora. Our Laboratory Director, Mrs Anjali Awasthi looks after the ART laboratory along with the Biologist, Ms Anuja Tamhane.
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The Keyhole Surgery Center clinical faculty includes Dr Swati Allahbadia, Dr Pritesh Naik, Dr Rajendra Sankpaland Dr Vivek Salunkhe, who perform Minimally Invasive Fertility Alleviation Surgery for our patients.
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SERVICES
Deccan Fertility Clinic and Keyhole Surgery Center offers a comprehensive range of infertility services under one roof. The Deccan Fertility Clinic's core team is known for their innovation, integrity, medical and technical excellence, personalized service, and consistent willingness to accept patients facing the most difficult medical challenges. Conveniently located at Shivaji Park (Dadar West), in the heart of Mumbai, the Center has all the facilities required to deliver a full range of services to couples requiring assistance conceiving. This ensures that patients are required to visit only one site for all stages of their diagnosis and treatments. Services offered at the Deccan Fertility Clinic include: Basic Work-up of the Infertile Couple One Stop Fertility Diagnostic Services including Hormonal Testing Uterine Cavity Assessment (Sonocontrast Hysterography) Gonadotropin Cycles
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Ovulation Induction & Monitoring Semen Processing Semen Cryopreservation Intrauterine Insemination In Vitro Fertilization (IVF)
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Intracytoplasmic Sperm Injection (ICSI) Embryo Freezing Blastocyst Embryo Transfer
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Donor Egg IVF
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Assisted Hatching Surgical Sperm Retrieval (PESA/Microscopic Epididymal Sperm Aspiration, MESA/TESE)
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Evaluation of Male Patient Recurrent Pregnancy Loss Clinic Minimally Invasive Ultrasound Guided Procedures Fallopian Tube Sperm Perfusion Diagnostic & Operative Laparoscopy & Hysteroscopy Reproductive Endoscopic Surgery including Fallopian Tube Recanalization
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Accommodation for out of town patients
To make your time spent in India for medical treatment hassle-free we have appointed an official Travel Manager. Adrian pinto and her team work round-the-clock to make your stay comfortable, facilitating a home-away-from-home experience, be it receiving you at the airport, hotel bookings, local transport, ticketing and visa support, sight-seeing or just helping you pick a last-minute gift for your family back home. From the time you arrive in India, up till the time of your departure, her team will ensure that your time is efficiently spent, pre and post treatment. Contact them today to find out more about the personalized services they provide to make your trip comfortable and memorable. Travel Manager - Reunion Holidays (Email ID - info@reunionholidays.com) Travel Manager - Celina (Email ID - travelnlogistics@gmail.com)
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TEAM We provide comprehensive services including Assisted Reproductive Techniques and Minimally Invasive Surgeries all under one roof, so patients don't need to shuttle from clinic to lab to the scan center. Our practice is restricted to treating infertile patients exclusively, and, we offer our patients the very best medical care- at affordable prices. The Deccan Fertility Clinic and Keyhole Surgery Center is an ISO 9001-2000 certified center.
If you have done IVF at another clinic, have you got upset that a different doctor attended to
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you each time? Are you forced to talk to a number of different nurses, with no real direction? Are you having trouble getting the feedback or explanations you need? At the Deccan Fertility Clinic all the treatment including the consultation, all the ultrasound scans, egg collection and embryo transfers are done personally by either Dr Gautam Allahbadia or Dr Sulbha Arora. The buck stops with us- and we don't delegate any part of your delicate and critical IVF treatment to anyone else! At Deccan, we recognize the importance of the healthcare team functioning as a coordinated unit in the overall treatment plan. Each member of the Deccan staff plays a critical role in providing high levels of reproductive healthcare. We acknowledge the skills and contributions of each team member and support education, outreach and research to enhance our staff's knowledge and further the field of reproductive healthcare.
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THE FACULTY Minimally Invasive Surgery Team Swati Allahbadia
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Pritesh Naik
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Rajendra Sankpal
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Vivek Salunke Anesthetists Yogen Bhatt & Associates Assisted Conception Team Laboratory Director Anjali Awasthi Biologist Anuja Tamhane
Clinical Associate Prajakta Pawar
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Andrologists Vijay Kulkarni
Andrologists Rupin Shah Endocrinologist Shashank Joshi Pathologists Avinash Phadke Pathologists Vandana Phadke Physician Sandeep Karembelkar Radiologist Mukund Joshi Scientific Director Sulbha Arora
Medical Director Gautam N Allahbadia
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VIRTUAL TOUR OF LAB
A Walk through our Facilities The environment, the equipment and the expertise at the clinic are par excellence. Patient safety is our motto. We are proud to have the 4th Generation Datex Ohmeda Anesthesia Monitor & Trolley for all surgical procedures. We have gone through the rigorous ISO 9000:2001 certification process during the pre-launch period itself. The attention to detail is evident from the moment you step into our laboratory. The human touch is maintained across the board, from the bedside manner of our associates to the privacy accorded to you by a slightly removed Semen Collection Room. An adjacent pass-through from the operating room to the IVF lab ensures that eggs that are being retrieved, or embryos that are being transferred, are not exposed to detrimental fluctuations in environment. The embryos are kept in four HeraCell incubators, which are monitored on a 24-hour basis to ensure appropriate culture conditions. The Microgalaxy workbench incubators complement the exacting work environment. If necessary, microsurgical procedures are performed at the micromanipulation work station. The Research Instruments (UK) Micromanipulation System with a third generation Saturn active diode laser offers ultimate performance and ease of use, with automated pipette set-up. We also provide facilities for cryopreservation of embryos for future use. After the procedure, patients are taken to our state-of-the-art Recovery Suite, where our caring staff tends to their needs.
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PRESS CLIPPINGS
2008 New legislation can help avoid Manji-like cases Times of India
India a hot spot for gay couples keen on babies Times of India
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Now, test-tube babies at half rate Times of India
2006 Kashmiris break taboo, go for test tube babies DNA India
2005 Infertile Muslims get reason to smile Times of India
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No Conflict between Science and Religion Times of India
2004 Hindistan' la Fransa' yi Bulusturan Kongre Kongre Gazetesi
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2001 Infertility can be overcome with new techniques: Dr. Allahbadia The Hitavada
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2000 The Genesis of Infertility The Sunday Review
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1997 Fertile couples create babies artificially The Mumbai Age, 19th March
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STATISTICAL ANALYSIS OF OUR GROUP SUCCESS RATES
CLINIC PREGNANCY RATES
YEAR SELF CYCLES Total No. 2000 2001 42 44 46 47 59 60 64 68 % CPR 26.2% 27.3% 30.4% 29.8% 30.5% 31.7% 31.3% 32.4% RECIPIENT CYCLES Total No. 11 20 29 33 56 46 70 99 % CPR 36.4% 40.0% 48.3% 51.5% 50.0% 52.2% 51.4% 51.0% ALL AGE GROUPS Total No. 53 64 75 80 115 106 134 167 % CPR 28.3% 31.2% 37.3% 38.8% 40.0% 40.6% 41.8% 43.1%
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2002 2003 2004 2005 2006 2007 (till 15th Sept)
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GLOBAL AMBASSADORS
Over the years, we have been lucky to get our patients from all over the world to vouch for our services, professional ethics, cleanliness & the ISO 9001-2000 International standards at our Center. These patients have experienced Rotunda first hand and have volunteered to communicate their experiences on email to other potential patients who are planning to visit India for their ART treatments. They know what doubts come into patients minds due to preconceived and mis-leading notions about the medical services in India & would like to dispel these doubts and allay anxiety with the purpose of sending the potential patients with confidence to take up treatment at Rotunda, Mumbai. Please feel free to write to our Global Ambassadors by clicking on the following links:
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India : Meeta ------ hopesnjoys@gmail.com Uday ------- udaysinh@yahoo.com Dr. Priyesh Tiwari ------ drpriyeshtiwari@rediffmail.com
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Mrs. Mona Ramprasad ------ mona.ramprasad@gmail.com Australia : Adele Pace ------- adelepc@yahoo.com Jyoti ------ jyotij1@yahoo.com Bahamas :
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Sangeeta ------ acp@clipgroup.com Canada : Mrs R -------- lightacandle123@yahoo.ca
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Denmark : H and K ------- kh2512@hotmail.com Israel : Dr Ilan Tal ------- drtal@post.tau.ac.il Pakistan : Mrs. Rukhsana Aziz ------ mrsrukhsanaaziz@yahoo.co.uk Spain : JDC ------- notho5@yahoo.es Derek Kehl ------- derekintorremolinos@hotmail.com UAE : Ajit ------ ajittomar@hotmail.com UK : Mr and Mrs Singh ------ Manjkee@hotmail.com USA : Ganesh -------- ganesh.sriganesh75@gmail.com Gita Carey ---------- gitacarey@yahoo.com Anita -------- anitakannan@cfl.rr.com / kannan@cfl.rr.com Sridhar ---------- Sridhar@cfl.rr.com Andalu Kasarla ------------ andaluks@yahoo.com
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SERVICES In Vitro Fertilization (IVF) Beginning an IVF cycle is an exciting and anxious time for a couple. Our Center provides couples with the maximum amount of clinical, emotional, and administrative support they will need to complete their cycle successfully - whether it results in a pregnancy or not. The following explanation is meant to simplify what occurs during various stages of IVF: Ovarian Follicle Development through Controlled Ovarian Stimulation
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Deccan Fertility Clinic uses fertility drugs that simulate the female partner, natural hormones to develop several normal follicles in the ovaries. These medications are Clomiphene Citrate also called Siphene® or Ovofar®; Menogon (HMG), a 50:50 mixture of FSH and LH hormonal administered intramuscularly; Puregon® (POFSH) administered subcutaneously; or Gonal-F (RecFSH). Any excess Oocytes that fertilize and develop into embryos at fertilization may later be stored through cryopreservation. Follicular growth, development, and maturity are evaluated through frequent hormone monitoring and by ultrasounds. Typically, the hormones estradiol, luteinizing hormone, and progesterone are measured through blood tests to evaluate ovarian response. Ultrasound is used several times during a cycle to measure accurately follicular growth and size. These steps allow the physician team to modify the treatment in some cases and to stop the cycle if the response to stimulation is not satisfactory. Once follicular maturation is achieved, the patient receives an intramuscular injection of human chorionic gonadotropin (hCG), which triggers oocyte maturation and ovulation. Oocyte retrieval is performed approximately 34 hours later.
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Embryo Retrieval through Puncture/Aspiration
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If the last hormone blood test and ultrasound evaluation indicates healthy growth of follicles, then aspiration of mature follicles takes place. This entire procedure takes approximately 20 minutes performed under short general anesthesia. The physician locates each follicle through ultrasonic guidance and carefully aspirates them. The contents of the follicles are immediately taken to the IVF lab. Patients usually recover for one to two hours following Oocyte retrieval and are then discharged. Progesterone supplementation is initiated from the day of the retrieval. Oocyte Culture, Insemination, and Fertilization In the IVF laboratory, follicular fluid is examined under a microscope to locate all eggs, which are then incubated in a special media. Generally, semen collection occurs at about the time of the egg retrieval but, in some cases, may be several hours later. The sperms are then added to the eggs in culture, here fertilization occurs. Any resulting embryos are stored in the incubator, and maintained in culture until the time of embryo transfer and/or Cryopreservation. Embryo Transfer Usually, transfer of the embryos takes place on day two to three post retrieval. The embryos are examined under the microscope and carefully aspirated to a thin transfer catheter. The loaded catheter is introduced under transabdominal ultrasound guidance through the cervix into the uterus where the embryos are placed. This procedure takes a few minutes and does not require anesthesia. After the transfer, the patient rests for two hours prior to discharge. Twelve days after the embryo transfer, a serum base pregnancy test is taken. During this period, patients are advised to perform light activity and remain in contact with the Center. If pregnancy does not occur, our team reviews the IVF cycle and makes specific recommendations for follow-up. The patient will speak with the clinical staff to review and if necessary, to discuss other options. Cryopreservation Embryos of sufficient quality that are not transferred can be cryopreserved. The embryologist will select embryos that are suitable for freezing. Embryos that are ideal for freezing have blastomeres of equal size and display minimal or no fragmentation.
A Word of Caution: There is approximately a 68% chance of survival following the cryopreserved embryos. The quality of embryos undergoing cryopreservation is a major determinant of survival. Depending on the stage of embryo development, frozen embryos are thawed for 2 days before the transfer. The patient is informed of survival of the thawed embryos and posted for a Frozen Thawed Embryo transfer ( FET). Ovarian Follicle: A small, fluid-filled structure in which eggs develop Oocyte: An egg Embryo: A fertilized Egg that has undergone division cleavage
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SERVICES Intracytoplasmic Sperm Injection Intra Cytoplasmic Sperm Injection (ICSI) is a laboratory procedure developed to help infertile couples undergoing In Vitro Fertilization (IVF) due to severe male factor infertility. ICSI involves the insertion of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a special microinjection pipette (glass needle). After sperm injection into the egg, further culture and embryo transfer is as with the IVF cases. For patients with subfertile semen, this procedure is preferable to IVF. ICSI can facilitate fertilization by sperm that will not bind to or penetrate an egg. It can also be used to treat men with extremely low numbers of sperm. However, ICSI is generally unsuccessful when used to treat fertilization failures that are primarily due to poor egg quality. Indications for Intra Cytoplasmic Sperm Injection Oligospermia - very low sperm counts Asthenozoospermia – poor sperm motility Teratozoospermia – too many abnormal sperms Problems with sperm binding to and penetrating the egg Antisperm antibodies (immune or protective proteins which attach and destroy sperm) of sufficient quality to prevent fertilization Prior or repeated fertilization failure with standard IVF culture and fertilization methods Frozen sperm collected prior to cancer treatment that may be limited in number and quality
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Azoospermia with obstructive pathology - absence of sperm secondary to blockage or
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abnormality of the ejaculatory ducts that allow sperm to move from the testes. In this situation, sperms are obtained from the epididymis by a procedure called microsurgical epididymal sperm aspiration (MESA) or from the testes by testicular sperm extraction (TESE). Thus very few azoospermic men need to resort to a sperm bank now with the availability of ICSI. ICSI is not a perfect technique. Some eggs will be damaged by the ICSI process. Some eggs have plasma membranes that are difficult to pierce. In other instances, the fertilized egg may fail to divide, or the embryo may arrest at an early stage of development. Perinatal outcome studies in Europe suggest that although multiple pregnancies are common with ICSI, there is no evidence of increased incidence of congenital malformations or abnormal karyotype. There is no evidence that abnormalities may arise later in life to babies born as a result of ICSI, although there is also no guarantee that all babies will be normal.
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DONOR EGG IVF
This is a wonderful treatment option for older women and women with ovarian failure. Our Egg Donation Program, unlike its western counterparts, does not depend entirely on Professional Egg Donors. We also have an Egg-Sharing Program where regular patients who require IVF and cannot afford it are ready to share half their harvested eggs. If the eggs are from a donor instead, the crop is usually divided between two recipients. Whether donated or shared, we try to ensure about 7-8 eggs per recipient on an average.Ours is an anonymous donor egg program. Our donors are screened for infectious diseases and also undergo a Thalassemia screen. Any other specific genetic test you wish can be done at an additional cost.
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Prior to undergoing the cycle, your menses may need to be coordinated with that of the donor. Subsequently, from day one of your menses, you will start a prescribed dose of Estrogen tablets (Progynova tablets or Estrace Tablets) to prepare your endometrium. Then once the donor gets her menses, we will begin her stimulation. She will be given Gonadotropin injections daily from day one of her menses for about 11 days within which she will be ready and will have formed multiple mature eggs in both her ovaries. If you are traveling here for your cycle, you will need to reach Mumbai only one day prior to the donor’s ovum pickup. This usually takes place on the 13th day of her cycle. An ultrasound guided embryo transfer will be done into your uterus two days later. You can travel back any time after the embryo transfer. Please feel free to write to us at deccanivf@gmail.com for further information.
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