In the laboratory, for ICSI treatments, the identified eggs are stripped of surrounding cells (also known as cumulus cells) and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs that can be fertilized, as it is required they are in metaphase II. There are cases in which if oocytes are in the metaphase I stage, they can be kept being cultured so as to undergo a posterior sperm injection. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.
A surge in LH triggers your ovaries to release an egg. The surge usually happens 36 hours before the egg is released. Ovulation kits check LH levels in your urine to help you pinpoint the day of ovulation. These kits, which you can buy at the drugstore, are convenient and highly accurate. You may want to test 1-2 days before you expect the surge so you can note the rise in LH.
Although menopause is a natural barrier to further conception, IVF has allowed women to be pregnant in their fifties and sixties. Women whose uteruses have been appropriately prepared receive embryos that originated from an egg of an egg donor. Therefore, although these women do not have a genetic link with the child, they have a physical link through pregnancy and childbirth. In many cases the genetic father of the child is the woman's partner. Even after menopause the uterus is fully capable of carrying out a pregnancy.[109]

A Cochrane review came to the result that endometrial injury performed in the month prior to ovarian induction appeared to increase both the live birth rate and clinical pregnancy rate in IVF compared with no endometrial injury. There was no evidence of a difference between the groups in miscarriage, multiple pregnancy or bleeding rates. Evidence suggested that endometrial injury on the day of oocyte retrieval was associated with a lower live birth or ongoing pregnancy rate.[30]
By 2012 Costa Rica was the only country in the world with a complete ban on IVF technology, it having been ruled unconstitutional by the nation's Supreme Court because it "violated life."[177] Costa Rica had been the only country in the western hemisphere that forbade IVF. A law project sent reluctantly by the government of President Laura Chinchilla was rejected by parliament. President Chinchilla has not publicly stated her position on the question of IVF. However, given the massive influence of the Catholic Church in her government any change in the status quo seems very unlikely.[178][179] In spite of Costa Rican government and strong religious opposition, the IVF ban has been struck down by the Inter-American Court of Human Rights in a decision of 20 December 2012.[180] The court said that a long-standing Costa Rican guarantee of protection for every human embryo violated the reproductive freedom of infertile couples because it prohibited them from using IVF, which often involves the disposal of embryos not implanted in a patient's uterus.[181] On 10 September 2015, President Luis Guillermo Solís signed a decree legalising in-vitro fertilisation. The decree was added to the country's official gazette on 11 September. Opponents of the practice have since filed a lawsuit before the country's Constitutional Court.[182]

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There is no one-size-fits-all solution to infertility, and the path you take will be unique to your specific case, but there are some common starting points. Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two of the most popular infertility treatments available today. Understanding what they are, who they are intended for, and what the success rates are for these two options will give you a place to begin your conversations with your fertility expert. Here’s what you need to know.

Gonadotropins are another drug used to trigger ovulation. Gonadotropins are used if other drugs are not successful or if many eggs are needed for infertility treatments. Gonadotropins are given in a series of shots early in the menstrual cycle. Blood tests and ultrasound exams are used to track the development of the follicles. When test results show that the follicles have reached a certain size, another drug may be given to signal a follicle to release its matured egg.
Complexity. IUI refers to one procedure. Prepared sperm is placed directly in the patient’s uterus when she is ovulating in order to aid fertilization. IUI may be performed in sync with a woman’s natural cycle or timed with fertility medications to stimulate ovulation. IVF, on the other hand, is a process which consists of several stages and requires more than one procedure: first the ovaries are stimulated using a series of fertility medications, then the patient undergoes egg retrieval in a day procedure under a mild anesthetic, then after embryos have been created and incubated in the lab, they are placed directly into her uterus in the embryo transfer procedure. Even with the use of fertility drugs, going through IUI is less physically demanding than undergoing IVF.
Assess your preconception prep. Have you been on top of the preconception game or are you just too busy for baby-planning activities like charting and timing baby-making sex (or any sex for that matter)? Given that you have a little one underfoot, it's understandable if you're more exhausted than ever. It’s not easy for wannabe second-time parents to devote as much time and energy to TTC as they likely did on the first go-around, but it would be helpful to take a step back (and a hard look) at what's going on. Are your cycles still regular, or have there been any changes that might be hurting your chances for conception success? Have you been able to pinpoint ovulation with accuracy, or are you just having sex whenever (which would make conception less likely)? Getting back on track with tracking your fertility signs may be enough to put you back in the game.

IVF success rates are the percentage of all IVF procedures that result in a favourable outcome. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the pregnancy rate, or the number of live births, called the live birth rate. The success rate depends on variable factors such as maternal age, cause of infertility, embryo status, reproductive history, and lifestyle factors.
IVF using no drugs for ovarian hyperstimulation was the method for the conception of Louise Brown. This method can be successfully used when women want to avoid taking ovarian stimulating drugs with its associated side-effects. HFEA has estimated the live birth rate to be approximately 1.3% per IVF cycle using no hyperstimulation drugs for women aged between 40–42.[63]

Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.


1. Educating About Infertility - Educating yourself about infertility is the first step towards your treatment. We believe that educating the patients about the problem associated with their pregnancy and the available treatment options can empower them to make better choices. When you understand better about the reproductive process, you will be able to decide when to seek help. We aim to achieve a healthy pregnancy for every patient.
Post transfer – You’ll likely take progesterone and estrogen to improve implantation and pregnancy rates. If the transfer is successful, a blood pregnancy test will be positive in 10-14 days. From there, ultrasounds are used to ensure the implantation site as well as check for a heartbeat. The good news is that once a heartbeat is detected, the pregnancy has a 90-95% probability of the pregnancy resulting in a live birth.
Previous tests should be carefully reviewed to ensure that the diagnosis is, in fact, "unexplained," and that no test has been omitted or missed. It may sometimes be necessary to repeat certain investigations. For example, if a previous laparoscopy has been done by a single puncture and reported as normal, it may be necessary to repeat the laparoscopy with a double puncture, to look for early endometriosis. 
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The Clearblue Fertility Monitor is for couples who are trying to get pregnant and want to track ovulation. It has a touch screen monitor that is easy to use, stores information that you can share with your doctor. It can also help you detect the most common signs of infertility by showing you what your fertile days are. If you have no fertile days, then you may be dealing with female infertility.
A recent large population-based study collected data from almost 5000 European patients. According to preliminary results presented at the 2019 European Society of Human Reproduction and Embryology, there is no benefit from ICSI in non-male factor cases. Importantly, the study reported no benefit of using ICSI regardless of how many eggs are retrieved after ovarian stimulation. Therefore, having a low oocyte yield should not be a reason for choosing ICSI over IVF.
Intercourse must take place frequently, particularly before and around the time of ovulation, and the couple must have been trying to conceive for at least one year (6 months if the woman is over 35 years old). Using these criteria, about 10-20% of all infertile couples have unexplained infertility. However, the percentage of couples classified as having unexplained infertility will depend upon the thoroughness of testing and the sophistication of medical technology. 

I found that I couldn't avoid the sense that we were not yet all here, that there was a person missing. In one of those strange confluences, I was, at the same time, writing a novel about a woman who had just given birth. I was spending my days at the fertility clinic and my evenings writing about the strange, shadowy world of early motherhood. My husband, coming into my study and finding me in tears again, laid his hand gently on the manuscript and said, "Do you ever think that writing this book might not be helping?" But you don't choose the books; they choose you. And if I couldn't bring a baby into being in real life, I was damn well going to do it in fiction.
A surge in LH triggers your ovaries to release an egg. The surge usually happens 36 hours before the egg is released. Ovulation kits check LH levels in your urine to help you pinpoint the day of ovulation. These kits, which you can buy at the drugstore, are convenient and highly accurate. You may want to test 1-2 days before you expect the surge so you can note the rise in LH.

In the laboratory, for ICSI treatments, the identified eggs are stripped of surrounding cells (also known as cumulus cells) and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs that can be fertilized, as it is required they are in metaphase II. There are cases in which if oocytes are in the metaphase I stage, they can be kept being cultured so as to undergo a posterior sperm injection. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.

Obviously, if the same couple decides to have more children at age 38, the chances won't be 25% anymore; it is likely that they are about 10%, which translates into a reduced pregnancy chance. This does not mean the couple has become infertile. Since they weren't absolutely fertile at age 32, it is only logical that their pregnancy chances at 38 are so low.

The penetration of the IVF market in India is quite low at present with only 2,800 cycles/million infertile women in the reproductive age group (20–44 years) as compared to China which has 6,500 cycles. The key challenges are lack of awareness, affordability and accessibility.[152] India in 2018 becomes the destination for Fertility Tourism because of most affordable IVF treatment cost. IVF treatment cost in India varies from $2000 to $4000 (roughly between 150000/- INR to 250000/- INR including all aspects of IVF treatment with medicines which is almost 5 times lower than IVF Cost in Western part of the world.
The Rand Consulting Group has estimated there to be 400,000 frozen embryos in the United States in 2006.[83] The advantage is that patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare oocytes or embryos resulting from fertility treatments may be used for oocyte donation or embryo donation to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm. Also, oocyte cryopreservation can be used for women who are likely to lose their ovarian reserve due to undergoing chemotherapy.[84]

The penetration of the IVF market in India is quite low at present with only 2,800 cycles/million infertile women in the reproductive age group (20–44 years) as compared to China which has 6,500 cycles. The key challenges are lack of awareness, affordability and accessibility.[152] India in 2018 becomes the destination for Fertility Tourism because of most affordable IVF treatment cost. IVF treatment cost in India varies from $2000 to $4000 (roughly between 150000/- INR to 250000/- INR including all aspects of IVF treatment with medicines which is almost 5 times lower than IVF Cost in Western part of the world.
Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.
At the same time, in older women, the IVF success rates can vary dramatically, and that’s why it’s so important to focus only on live births. For example, a clinic may have a very high pregnancy rate among older women, but a low live birth rate. Or, the rates may be quite high – 40% or even 50% – but only after four or five rounds. That makes a very big difference, especially in the overall cost of treatment!
Post transfer – You’ll likely take progesterone and estrogen to improve implantation and pregnancy rates. If the transfer is successful, a blood pregnancy test will be positive in 10-14 days. From there, ultrasounds are used to ensure the implantation site as well as check for a heartbeat. The good news is that once a heartbeat is detected, the pregnancy has a 90-95% probability of the pregnancy resulting in a live birth.
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