FAQs

1. What sets IVF Access apart from other fertility clinics?

Our experience has taught us that the Fertility process can be stressful and emotional.

IVF Access aims to be the clinic where we understood your emotional journey and focus on:

• Empathetic Experience
• High standards of care
• Ethical communication
• Transparent pricing

2a. How long should we try to conceive before we see a doctor?

• If you are under the age of 30 and have been trying to conceive for more than one year, we recommend that you consult our fertility specialist
• If you are over the age of 30 and has been trying to conceive for more than six months, we recommend that you consult our fertility specialist
• Remember that infertility is found in both men and women and it affects nearly an equal number of men and women. 1/3rd is attributed to the female partner, another 1/3rd is attributed to the male partner and the remainder is caused by a combination of problems in both partners
• However, about 20 percent of infertility cases remain unexplained even after a full diagnosis

2b. My husband has a low sperm count and we are not ready for adoption. What are our options?

There are many treatable causes for male infertility. Our consultants begin with taking your complete history and check if we can prescribe hormones to stimulate sperm production.

Alternatively if there is a severe male factor issue, we may advise you to seek a male donor

2c. How do you test for male fertility?

• While IVF Access has several tests to assess male fertility, we start with an initial semen analysis.
• If you have normal sperm count and good motility, you do not typically need further tests
• If you have abnormal sperm results, IVF Access recommends additional blood tests, genetic studies, and testicular biopsy

2d. Is infertility a common issue?

About 15% of couples wishing to start a family will have an infertility challenge. Please remember that Infertility is not just a woman’s problem. After diagnosis, 1/3rd of cases will involve a female factor, while 1/3rd of the time, it be a male factor. The remaining could be both or unexplained infertility

2e. If our family has had a history of infertility, will it impact us? Can a diet regimen help?

Yes, it could impact you. A family history of pregnancy loss or infertility may point to genetic issues. We would be able to recommend genetic testing to diagnose any family related problems

We will work with you to create a comprehensive treatment plan which will include diet and lifestyle changes

2f. Does stress cause infertility?

Several recent studies have found links between the women’s levels of day-to-day stress and lowered chances of pregnancy. At the same time, if you are stressed, your frequency of intercourse may also have reduced. Smoking, alcohol and substance abuse among others are known contributors to reduced fertility.

3a. What are the likely symptoms of infertility?

Some common symptoms for women are:

• Abnormal, irregular, or painful periods or even no periods
• Skin changes, including more acne
• Unexplained weight gain
• Reduction in sex drive
• Hair growth on face and body
• Loss of hair or thinning hair
• Painful Intercourse

Some common symptoms for men are:

• Swelling and pain in the testicles
• Erectile dysfunction
• Reduction in sex drive

3b. I have a low AMH count. How does that impact my fertility?

Your level of AMH helps to predict how well your ovaries will respond to stimulation during an IVF cycle.

It can be used to prescribe accurate dosage of stimulation drugs to you, and we also use it to de-risk patients who are at a higher risk of ovarian hyperstimulation syndrome (OHSS).

If you have low AMH or a low antral follicle count, then the chances of becoming pregnant are lower, but this reduction is normally age related

4. How does age impact fertility?

For women:

• Age is the most important factor that reduces a woman’s fertility.
• A woman is born with all the eggs she will ever have
• As you age, your eggs also age, & they diminish in quantity & quality
• At age 30, your chance of conceiving naturally each month is about 20 percent. At age 40, it is about 5 percent

The decline in fertility is also aggravated by lifestyle and health issues such as a being underweight or overweight, smoking, excessive alcohol consumption, sexually transmitted infections, chemotherapy or radiation, and chronic health problems.

For men:

• The quality of a man’s sperm decreases with age starting at age 40
• Declining fertility, occurs much more slowly in men than in women

5a. What will happen on our 1st visit?

IVF Access will conduct your evaluation in our state-of-the-art fertility centers. Our expert consultants will meet with you to review your previous medical records and past medical history.

The first consultation generally lasts for about an hour and includes a detailed physical examination and ultrasound scan. A semen analysis will be performed on the male partner, and a hormone screening will be performed on the female partner. Our consultants may also advise you to undergo an evaluation of tubal patency (whether the fallopian tubes are open or blocked) and the uterine cavity

We encourage you to:

• Meet us as a couple since it is important for both of you to understand the journey ahead, and also because this equally affects men and women
• Know your consultant
• Receive explanations and answers to your questions and concerns

Once our IVF Access consultant establishes a diagnosis, we will formulate a personalized treatment plan for you.

5b. What would be the basic background info needed by the doctor for preliminary diagnosis?

We understand that this is a private issue for most couples. Some of the information that our doctors would need for diagnosis are:

• Have your cycles been regular? Talk to us about the length of your cycles. And any discomfort?
• How long have you had intercourse without birth control? How long are you trying to conceive?
• What is the frequency? Do you have any family history of pregnancy loss or any genetic issues?
• Any previous reports & medical history including surgeries

5c. What tests might be needed for preliminary diagnosis?

Other than an ultrasound scan, our clinicians may prescribe the following blood tests:

• For the wife: We normally recommend the following tests on Day 2 of your cycle to assess your fertility health. These blood tests indicate how well and how often you ovulate and whether your lining is thick enough for implantation. These are
• Anti-Mullerian hormone or AMH – your ovarian reserve size
• Follicle-stimulating hormone or FSH – to stimulates ovaries
• Luteinizing hormone or LH – to stimulate oocyte release
• For the husband: We provide for a clean, private room for semen collection. These rooms are next to our Andrology Lab so that the samples are immediately processed to ensure high survival rates. We check for:
• Motility: which indicates % of traveling sperm
• Volume: which indicates millilitres of semen
• Morphology: which indicates shape of sperm
• Concentration: which indicates million sperm per millilitre

6a. All our tests are normal, and we have no health issues. Why can I not get pregnant?

Approximately 20% of our couples will have normal test results and are diagnosed as unexplained infertility. Please consult our Fertility experts to review your report and develop a personalized treatment plan.

6b. What are your hours of working? Do you work weekends?

We are currently open Monday – Saturday from 8:00am until 5:00pm. On specific requests we can also schedule appointments on Sundays

Our mission is to improve accessibility at your request. We would be happy to schedule appointments outside our working hours

6c. Is male infertility common these days? Does medicines can actually improve the motility?

Male infertility has been on the rise recently.

Our clinicians will do a thorough physical examination and medical history for the male partner including development during puberty.

If the semen analysis is abnormal, we may recommend additional tests to help identify the cause of infertility. These may include:

• Ultrasound: which can diagnose varicocele issues or problems in the testes or tubal blockages
• Hormone analysis: Certain abnormalities in hormones may contribute to infertility
• Ejaculation analysis: where sperm is present in your urine
• Testicular biopsy: to analyze additional blockages or sperm transport issues

Treatments for male infertility include:

• Varicocele Surgery
• Treatments for sexual intercourse issues as erectile dysfunction or premature ejaculation.
• Hormone medications

In rare cases, male fertility problems cannot be treated, and it is impossible for a man to father a child. Your doctor might suggest considering using sperm from an anonymous donor

7. Do you provide medications?

Yes. IVF Access has invested in advanced cold chain technology which allows us to source the most appropriate drugs and handle them carefully at low temperatures to maintain drug potency

We may prescribe medications such as:

• Clomiphene citrate – This is an oral medication used to stimulate ovulation and is most commonly used to treat unexplained infertility by increasing the number of eggs produced
• Letrozole – This oral medication is used to stimulate ovulation and is now commonly prescribed for patients with polycystic ovary syndrome (PCOS)
• Human menopausal gonadotropin or hMG – This is an injected drug often used to induce ovulation in women who are unable to ovulate
• Follicle stimulating hormone or FSH – This is an injected drug often used to induce ovulation for women
• Gonadotropin-releasing hormone (GnRH) analogue agonist – These are injected drugs and are used to prevent ovulation from occurring too early in a stimulation cycle

8a. Are the daily IVF injections painful?

These injections are a necessary part of IVF treatment and IVF Access will design your injection schedules to minimize discomfort and stress. Our highly trained nurses will support you throughout this process

After oocyte retrieval, we may prescribe a progesterone hormone supplement to prepare the uterine lining either in a vaginal tablet or vaginal suppository form rather than an injection

8b. Is the OPU procedure painful?

OPU (Oocyte Retrieval) is a minor procedure and is done under general anesthesia and thus you will not feel any pain during the procedure.

Post anesthesia wearing off, you may feel some minor cramping that can be treated with medications

8c. How often do I need to visit the clinic?

Once we start your treatment, you will be required to come in for a quick daily injection for about 10 days and 3-4 monitoring visits

The OPU procedure lasts about 30 minutes in the morning and the Embryo transfer is 15 min

9. Is IUI really useful?

IUI doubles a woman’s chances of getting pregnant as compared to natural intercourse.

This is because our consultant will place your husband’s sperm near your tubes where fertilization occurs. This procedure will only be done when you are ovulating, and your ovaries are releasing mature eggs for fertilization. This is the time when a woman is most fertile.

10. Do I need to abstain before my semen analysis?

We advise you to abstain for 48 hours prior to a semen analysis.

11a. If I have additional embryos, can I freeze them for later?

IVF Access can freeze embryos that are not transferred provided they are of a suitable quality. IVF Access has developed its custom protocols for fast freezing which are then completely immersed in liquid N2. These embryos are held in a suspended state and do not deteriorate with time in storage.

At the time of embryo transfer our Consultant will discuss with you the quality of the embryos for transfer and any remaining embryos and will advise you if these meet the criteria for freezing

11b. How long will you freeze my embryos for?

IVF Access will store your embryos for a period of 5 years. We will inform you 6 months before the period of storage is due to end. Your choices at the end of the storage period are:

• To use the embryos for treatment before the end of consent period
• To extend storage
• To donate the embryos for research

12. I have PCOS. How does that affect me? Can it be treated

Polycystic Ovary Syndrome (PCOS) is a common ovulation problem for women, where ovulation is irregular, and oocytes may not be released. The oocytes instead are loaded with fluid and they turn into cysts. This condition should not be left untreated. You may have PCOS if:

• If your periods are irregular, infrequent, or missing
• If you have frequent miscarriages
• If you have excess facial and body hair
• If you are obese
• If you have diabetes
• If your tests show irregular levels of FSH and LH

If you have PCOS, we will review your medical history and create a personal treatment plan that unites the following:

• Fertility treatment with Clomiphene to help you ovulate
• Nutritional changes to your lifestyle and weight control

13a. I have Endometriosis. How does that affect me? Can it be treated

Endometriosis is a condition where the endometrial lining is discarded via the fallopian tubes and not the cervix. This causes the lining to grow around the ovaries leading to inflamed tissues and pain. If you leave it untreated, it can prevent you from conceiving. You may have Endometriosis if:

• If your cycles are painful and bleeding is excessive
• If you suffer pain during bowel movements
• If you have dysmenorrhea (or pain after intercourse)

If you have Endometriosis, we will review your medical history and create a personal treatment plan including:

• Direct IVF – which we recommended
• Surgery – which is performed when significant endometriomas or lesions are observed

13b. I have had recurrent pregnancy loss. Can you help me?

Regrettably, pregnancy loss or miscarriage does happen in 10 to 15% of the cases within the 1st trimester. Two or more failed pregnancies is referred to as recurrent pregnancy loss.

This maybe because of genetic abnormalities or uterine issues. If you have septum in your uterus, the rate of loss may be three times the rate of miscarriage. If you have submucosal fibroids, we will recommend removal to improve fertility rates. Other factors include advanced age, fibroids and polyps, chronic infections of the fallopian tubes and smoking/drug use. We may also recommend polyp removal if the size and position impact your fertility

The skilled clinicians at IVF Access will carefully understand your background for specific family history, hormonal, uterine and genetic issues. A personalize a treatment plan would be developed to provide you with empathetic support towards your next conception

14. What is my ovarian capacity?

For a woman, the ovarian reserve is finite. If you have more oocytes, then you have a higher change of conceiving.

You are born with a fixed number of oocytes. And as you age, this reserve declines. The highest decline happens after 30 years and these are also impacted by genetic issues. Therefore, your ability to conceive slows down with age.

Common Infertility Terms

• AMH or anti-Müllerian hormone: This AMH is a good predictor of your ovarian reserve. This is a protein produced by the granulosa cells in ovarian follicles. AMH levels are indicative of number of follicles remaining
• Beta HCG: This is a blood test for the hormone BhCG, which increases in the early stages of pregnancy
• FSH or follicle-stimulating hormone – This is released by the brain to stimulate the follicles to grow and develop.
• hCG or Human chorionic gonadotropin: This is a hormone produced during pregnancy. Your levels of hCG increase in the early stages of pregnancy
• HSG or hysterosalpingogram: This specific scan determines tubal patency. Your doctor will inject a dye inside your cervix and examine your uterine cavity to check if the fallopian tubes are patent
• ICSI: Intracytoplasmic sperm injection (ICSI) is a treatment used when the sperm is unable to penetrate the oocyte. Our embryologist will select a single healthy sperm and inject it directly into the Oocyte.
• LH or Luteinizing hormone: This is produced by the gonadotropin cells in the pituitary gland. In women, the rise of LH triggers ovulation, or the release of your oocytes
• OHSS: OHSS stands for ovarian hyperstimulation syndrome, a rare complication of ovarian stimulation. This occurs when you develop fluid in the abdomen and have enlarged ovaries
• Progesterone: is a hormone to check if & when ovulation has occurred. It normally surges before ovulation
• Semen analysis or SA: This is performed prior to an IVF treatment cycle in order to evaluate the sperm’s potential to fertilize an egg. A semen analysis tells our consultant if the sperms are present, normal, and the motility