Dr Manjunath IVF

What if I tell you, that you can become a father with nil sperm count! Yes, You heard it right. A nil sperm count or zero sperm commonly known as Azoospermia, there could be two probable conditions for this cause- non-production of sperms or presence of any blockages preventing the sperm from reaching the ejaculation phase.

So how is it possible for a man with nil sperm count to become a father?

Thanks to the highly technical advancements and recent research developments in the medical field through which reproduction is made possible for men with less or no sperm count. There are some commonly known procedures available which are Testicular Sperm Aspiration (TESA) and Microsurgical Epididymal Sperm Aspiration (MESA). Another recommended treatment for male infertility and low sperm count is a form of micromanipulation called intracytoplasmic sperm injection (ICSI), a laboratory procedure in which sperm and eggs are retrieved from both partners, and then a single sperm is injected into an egg.

What is the success rate and how is the procedure carried off?

Out of 8 to 10 cases performed, the success rate is generally good- as 40-50%. The two methods used for sperm retrieval, TESA and MESA Testicular Sperm Aspiration (TESA) and Microsurgical Epididymal Sperm Aspiration (MESA). As for the MESA technique, it has its indications. It improves sperm retrieval and diminishes the amount of tissue that is removed from the testicle. Generally, a microscope or a surgical loupe is required. With TESA, analyses from different parts of the testicle are biopsied. Sperm aspiration is performed prior. The aspirated tissue is then processed in the embryology laboratory and the sperm cells are extracted are used for ICSI.

A word of concern-

Azoospermia is a severe cause of male infertility, but there is a high hope for men to have a genetic child after diagnosis. Seek support from our professional expertise. You don’t need to go through this alone.

If you have any more questions, contact our IVF expert regarding your evaluation or management.

This blog was medically reviewed by Dr. Manjunath

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Every day that passes without a favorable pregnancy test result can be tough on couples yearning for parenthood. The number of couples affected by infertility is growing today with environment, stress and lifestyle wreaking havoc of our reproductive health.

Reproductive system organs also play a major role in causing infertility. Tubal block is a major reproductive organ disorder encountered by women today. It is reported as the main cause in about 40% of the total cases of female infertility reported so far.

Tubal block is termed as a condition where one or both of the fallopian tubes are blocked which hampers the movement of egg and sperm, effectively preventing fertilisation from taking place. This block needs to be treated and removed for restoring fertility.

The success of a treatment depends greatly on the quality of the treatment Center opted for. We know what it means to you while you seek treatment for fulfilling your wishes for a baby, the hopes and trust you put in the hands of the doctor. Dr. Manjunath is dedicated to providing you the best treatment and support to walk you through the dark times.

With an updated infrastructure and a skilled panel of doctors, embryologists and other professionals, we are committed to providing treatment based on the cause of infertility. Our treatment pattern involves an individualized approach that is planned after thoroughly evaluating the patient’s medical history.

Women with tubal blocks do not show any symptoms usually. However, in some cases of tubal blocks like hydrosalpinx, unusual vaginal discharge and lower abdominal pain are encountered. Tubal blocks are usually detected during the diagnostic tests done by our doctors.

The diagnostic tests that are usually conducted to detect the cause of infertility include ultrasound and blood tests to check for the presence of infections. HSG or Hysterosalpingogram, a procedure of using dye to detect blockage is used in cases where tubal blocks are suspected.

Tubal blocks result in infertility and hamper the chances of having a baby when both of the Fallopian tubes are affected. Laparoscopic surgery is effective in removing these blocks to restore fertility.

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A hurdle to anything you yearn for is quite disturbing, but a mindset robust enough to overcome it is a need of the day. IVF offers that to hopes shrivelled by infertility. The overall transformation in lifestyle, climate and environment has caused a rampage on our hopes and dreams with a growing incidence of conditions like infertility.

Scope of IVF treatment

IVF treatment is suitable for couples who are unable to conceive due to conditions as mentioned below: –

Due to conditions like endometriosis which hampers female infertility.

Male infertility caused due to low sperm count.

Irregularities in fallopian tubes or uterus which hinder natural fertilisation.

Irregularities in ovulation.

Antibody problems in either partners causing harm to egg or sperm

Inability of sperm to survive within female body.

In cases of unexplained infertility.

IVF is usually used when other modes of treatments like medications and other procedures fail to bring about a desired result.

IVF Procedure

The procedure of IVF is initiated with collection of sperm and egg. In the female partner, hormones are injected to ensure multiple egg production during ovulation than one in normal cycle. A procedure for egg retrieval is then conducted to remove the eggs from the follicles. In men, the sperm is collected either by masturbation or directly from the testes through a procedure.

The collected egg and sperm are then fertilised in a laboratory setting for about 3 to 5 days after which it is implanted in the mother’s womb. The process involves the insertion of a tube called catheter into the uterus through the vagina and cervix, for depositing the embryos there. For better chances of successful conception more than one embryo is transferred.

Success rate of IVF

IVF has known to create successful results, even in severe cases of infertility. However, the probability for success is highly dependent on the age of the patients, cause of infertility and so on.

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Planned oocyte cryopreservation- planned OC, is an emerging but ethically permissible procedure that may help women avoid future infertility.

Throwback

The first reported birth from cryopreserved oocytes was in Australia 1986 by “slow freezing” technique which is actually an older technique. Since then many advances has happened in the field and a new process called “Vitrification” or “Fast Freezing” has become more widely used.

What is Planned OC, (Egg Freezing)?

The process of fertility preservation would involve initial assessment of the ovarian function with blood tests and pelvic ultrasound. Basically, preserving a woman’s potential for becoming a genetic mother is now possible.

Reasons to consider for fertility preservation

· Immediate threat to fertility due to chemotherapy

· Surgery associated with ovaries with a high risk of damage

· Family history of premature ovarian failure

· Delaying pregnancy for personal and social reasons.

Factors to be considered to achieve successful egg freezing

· Freezing the eggs younger is better

· Egg Freezing is an insurance against age related infertility

· Should be done in well equipped lab and with an expertise

· Egg Freezing may stop cryopreservation oocytes from aging but it does nothing to reduce the risks of pregnancy at advanced maternal age.

Things to keep in mind before freezing the eggs

· A hormonal injection therapy and egg collection procedure has to be done and this is a 90% successfully attained (provided approx 35–40 eggs in 2 or 3 cycles of stimulation). Yes, this means at least 2–3 cycles has to be collected.

· Ideal age to score the egg is between 28- 35 years. Older women above 35yrs have lesser yield of eggs and less successful cycles.

How is Egg freezing achieved?

Firstly, your fertility specialist may perform an assessment of the ovaries which includes blood tests and pelvic ultrasound. This assessment will help to determine the necessary dose of medications. Ovarian stimulation is carried out using injectable hormonal medications. Following the stimulation, the oocytes and the fluids are aspirated vaginally.

Finally, the eggs are assessed under the microscope and those that are matured are cryopreserved.

How can the eggs be used in the future?

The cryporeserved eggs are placed in warming solutions and assessed; those eggs that survived the freezing process are fertilized with intracytoplasmic sperm injection (ICS) where a single sperm is injected directly into the egg and then the fertilized egg will grow in culture until the embryos are ready to be transferred into the uterus to achieve pregnancy.

What are the chances of a successful pregnancy with POC?

In general, the two most important factors in determining the probability of a live birth are the woman’s age at the time of egg freezing and the number of available eggs. However, Clinical pregnancy rates have been estimated 4–12% per oocyte.

A common concern of information

Number of women opting for POC for future use is becoming more and more as the awareness among working class of women is increasing. Multinational companies like Google are supporting POC with a package of incentives. According to SART( American Society for Assisted Reproductive Technology) a minimal of 475 women underwent POC in 2009, however the number increased to 9042 in 2017 and much more in 2019.

Where are we now?

Oocyte cryopreservation is an established component of ART, with vitrification now being the cryopreservation technique of choice. Increasing numbers of women undergo oocyte cryopreservation for both medical and social reasons. It is important to continue auditing outcomes and reporting long-term follow-up of children born from frozen–thawed oocytes.

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Surrogate is a misunderstood term and when people refer to a “surrogate,” they intend to refer to a woman who carries a pregnancy for another person. However, the proper term is a gestational carrier.

The person or couple trying to have a baby with the help of gestational carriers are called intended parents.

What is the difference between traditional Surrogate and Gestational Surrogate?

In Traditional Surrogacy, the surrogate’s egg is used making her the biological mother of the child she carries. The egg is fertilized using sperm from the intended father or a donor using intrauterine insemination.

In Gestational Surrogacy, the surrogate has no biological link with the baby. The embryo is created using an egg from the intended mother or a donor and sperm are taken from the intended father or a donor using in vitro fertilization. Once the egg is fertilized in the laboratory, the embryo is then transferred to the surrogate.

When do you need Surrogacy?

Medical problems with the uterus

Prior hysterectomy

Unexplained repeated miscarriages, not resolved by other treatment

Repeated embryo implantation failures during IVF treatment

Medical conditions that make pregnancy life-threatening to the mother or baby, including severe heart disease, lupus, history of breast cancer, severe kidney disease, cystic fibrous, severe diabetes.

Finding a Surrogate:

You can ask a friend or family member to be your surrogate mother but it involves several family issues and its somewhat controversial. Sometimes raises legal parental issues or can use a Surrogate agency. Some people look for independent carriers — that is, looking for a gestational carrier (that is not known to you) without the help of an agency.

The Surrogacy Process in India

In the Gestational Surrogacy process in India, there are three possibilities for the conception of the child.

Using egg and sperm from the intended parents. In this, both intended parents would be genetically related to the child.

Using either egg or sperm from one intended parent, in combination with donor egg or sperm. Here, one intended parent would be genetically connected to the baby.

Using both donor egg and donor sperm. In this situation, the intended parents would not be genetically related to the child. Using donor embryo. This would not lead to genetic relation to the baby.

After all the legal procedures of finding a gestational carrier and deciding of fees is done the actual process begins where,

The gestational carrier and the intended mother have their cycles put in sync with birth control pills and then hormonal injections. Once the treatment cycle begins, the intended mother will go through the IVF treatment.

In the meantime, the gestational carrier will take hormones to help prepare her uterus for embryo transfer.

The intended father will provide a semen sample to the clinic and the retrieved egg will be combined with the sperm. Any resulting embryos will be observed for a few days.

Then, three to five days after the retrieval, some embryos will be transferred to the gestational carrier’s uterus.

If the cycle is successful, once a heartbeat has been detected, the gestational carrier will be cared for by her regular doctor. The communication between the gestational carrier and intended parents can be direct or through a mediator depending on the kind of arrangement agreed to before the process.

When the gestational carrier is verified to be in labor. The hospital should be told about the surrogacy arrangement beforehand, so proper communication and access can be provided for all involved.

After childbirth occurs, the parents should get to hold the baby soon after birth. In some arrangements, the gestational carrier agrees to provide pumped breast milk for the baby for a certain period of time.

The attorney should arrange the parental rights or pre-birth order paperwork before birth, and it should be available at the time of the baby’s birth. This will help get the intended parents’ names on the birth certificate, instead of the gestational carrier’s name.

If the IVF cycle will not be successful and several cycles will be attempted. It’s also possible for the IVF cycle to be canceled midway for medical reasons, because of no embryos to be viable, for the gestational carrier not become pregnant even with viable embryos, or for the gestational carrier may miscarry.

All of these situations should be discussed prior to the contracts being signed, to be sure the gestational carrier and intended parents agree on how to handle the situations.

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The process of reproduction is a natural process for most couples, but however, some couples may go through certain complexities for which it gets difficult to conceive. Fertility of a man depends on the quality and quantity of sperm production. If the sperm count is too less it will be difficult to conceive which leads to problems and complexities. Male Infertility depends on a variety of factors but usually depends on the quality of his sperm.

In today’s era, infertility has become a common problem. Almost 6 out of 10 couples go through this problem. For men, the rate of infertility problem is even higher. This mostly depends on the unhealthy and stressful lifestyles we lead. Generally, there are not many symptoms visible in naked eyes as there will be no difficulty while intercourse, erections or ejaculations. When medical tests are conducted the quality & quantity of the sperm can be seen.

There is no safe limit for smoking, the only way to protect yourself and your unborn baby from harm is to quit smoking. According to various researches it is found that men who smoke have a higher chance of infertility as compared to men who don’t smoke. The harmful chemicals in cigarettes can cause damage to eggs and sperm which affects a future child’s health as well. A healthy baby starts with healthy sperm and healthy eggs. The good news is that the effects of smoking on eggs and sperm and fertility are reversible which means if men quit smoking it will increase the chance of conceiving and in turn them having a child through the natural process.

Impact of Smoking on Sperm and Semen Quality-

Smoking has a harmful impact on both health and the fertility of male.So, if you are looking forward to beginning a good and healthy family with natural means of reproduction you should quit smoking today.

1.Sperm Concentration- Sperm concentration means the number of sperms that are found in a measured quantity of semen. Research has shown that if men smoke it leads to a 23% decrease in sperm concentration which affects the fertility of men.

2.Sperm DNA: Research has shown that men who smoke have increased DNA fragmentation. DNA damaged sperm may lead to problems with fertilization, embryo development, embryo implantation, and increased miscarriage rates. Male smokers may also have abnormal hormone levels, which can affect fertility.

3.Sperm morphology: Sperm morphology refers to the shape of sperm. Male smokers tend to have oddly shaped sperms which may not swim well enough to get to the egg and may not be able to fertilize an egg. If the egg is fertilized only then will the couple have a child, but for male smokers due to oddly shaped sperms this might be difficult.

4.Sperm motility: Sperm motility refers to the swimming capabilities of the sperm. When the sperm is not capable of swimming properly they have a lot of trouble in reaching the eggs and hence have trouble in the fertilization process. Research has found that men who smoke have a decrease of 13% in sperm motility.

Summary-

Smoking has a harmful impact on both health and the fertility of male.So, if you are looking forward to beginning a good and healthy family with natural means of reproduction you should quit smoking today.

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Fallopian tubes are a part of the female reproductive organs that connect the ovaries with the uterus. Every month during ovulation, which occurs roughly in the middle of a menstrual cycle, the fallopian tubes carry an egg from an ovary to the uterus. Conception also happens in the fallopian tube. If an egg is fertilized by sperm, it moves through the tube to the uterus for implantation.

If a fallopian tube is blocked, this will lead to a blockage in the passage for sperm to get to the eggs, as well as the path back to the uterus for the fertilized egg, is blocked. Common reasons for blocked fallopian tubes include scar tissue, infection, and pelvic adhesions.

Symptoms of blocked fallopian tubes

There are often no symptoms of the blocked fallopian tubes, in fact many women don’t even get to know that they have blocked fallopian tubes until they try to get pregnant and have trouble conceiving.

For some women, it might lead to mild, regular pain on one side of the abdominal wall. Conditions that can lead to a blocked fallopian tube can cause their own symptoms. For example, endometriosis often causes very painful and heavy periods and pelvic pain. It can increase your risk for blocked fallopian tubes.

Azoospermia is a medical condition of a man whose semen contains no sperm. It is analogous with infertility, but few forms are amenable to medical treatment. It may affect 1% of the male population and can be seen in up to 20% of male infertility situations. Due to medical advancements, now depending on the type of azoospermia,it can be surgically treatable with a return of ejaculated sperm or through sperm retrieval and assisted reproduction to achieve successful pregnancy.

Symptoms of Azoospermia-

Couples who are trying to conceive and face infertility which means even after having unprotected intercourse for 1 year the female partner fails to get pregnant. Infertility is the first sign that something may be wrong with either of the partners. There are few symptoms that may lead to azoospermia-

Low ejaculate volume or a dry orgasm which means there is little or no semen during ejaculation.

Cloudy urine after having sex.

Pelvic pain or swollen and smaller testicles.

Difficulty with erections or ejaculation.

Reduced male hair growth.

Muscle loss.

Type and Causes of Azoospermia-

1.Pre-testicular Azoospermia- It is non-obstructive in nature and is caused due to the poor production of sex harmones. The follicle-stimulating hormone (FSH) levels are low that commensurate with inadequate stimulation of the testes to produce sperm.

This type of azoospermia is caused due to-

Kallmann syndrome: It is a genetic or an inherited disorder which is carried on the X chromosome and is marked by low levels of gonadotropin-releasing hormones (GnRH) with a loss of smell.

Disorders of the Hypothalamus (a part of the brain)- Any kind of damage to the hypothalamus or the pituitary gland, may also cause this type of azoospermia. If a person is undergoing certain medications or having radiation treatments for cancer that can also be a cause of this azoospermia.

2. Testicular Azoospermia- This type of azoospermia is non-obstructive in nature and is caused when the testes are abnormal, atrophic, or absent, and the sperm production is also severely disturbed. This condition can be seen in 49–93% of men with azoospermia. The testicular failure includes absence of failure production as well as low production and maturation arrest during the process of spermatogenesis.

The Testicular Azoospermia may be caused due to-

Klinefelter Syndrome- It is caused by two or more X chromosomes in males. The main feature of this syndrome is that it causes male infertility and the poor functioning of testicles. The symptoms could be weaker muscles, greater height, less body hair, and less interest in sex. These symptoms are often noticed at the puberty stage.

Other causes can be diseases like diabetes, cirrhosis or kidney failure.

3.Post-Testicular Azoospermia- This condition occurs in about 40% of men with azoospermia This is obstructive in nature and is caused by problems with ejaculation due to an obstruction of some sort in the reproductive tract.

The Post-Testicular Azoospermia may be caused due to-

Congenital Bilateral Absence of the Vas Deferens (CBAVD)- It is a genetic disorder in which the vasa deferentia is absent at birth. Men with CBAVD have a high risk of being a carrier of cystic fibrosis.

It may also be caused due to injuries, growth of a cyst, or infection.

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Pre-conception nutrition is the most essential part of fitting own self up for pregnancy. Most Importantly upcoming mothers should concentrate more on weight such as your weight compared with your height and what food you are having for lunch or dinner will play a vital role in your health during this time and the health of your growing fetus.

Pre-pregnancy weight will straight away influence your baby's growth. If you'll do research you’ll find that underweight women are more likely to gives birth to small weight babies, even though they may gain the same amount in pregnancy as normal-weight women. Overweight women have increased risks for problems in pregnancy such as thyroid, diabetes or high blood pressure. So, there should be proper weight and as per that proper proportion of nutrients should be eaten to be healthy so that baby also is a healthy baby and mother will also be fit and healthy after pregnancy.

List of nutritious substance to maintain weight and growth

The following are some advice on how and what to eat to lead a healthy life during pregnancy. Making sure you’re having proper food and avoiding unhealthy nutrition, and also maintain a balanced lifestyle. By maintaining this you will give your body a particular shape to make, and then grow, a baby.

Leafy Green Veggies like spinach, kale, broccoli, etc. Which are rich in fiber, vitamin C, vitamin K, vitamin A, calcium, iron, folate and potassium. vitamin which helps a pre-pregnant woman to prevent neural tube defects, including spina bifida, during the earliest stages of fetal development. Don’t eat only salads every day have enough quantity of food affording to your need.

Coconut oil is very good if includes regularly in your pre-pregnancy diet. It can help settle your digestive system. A spoonful of this oil can help relieve pregnancy nausea as well as Hyperacidity. You can even add this oil heartburn soup Or bowl full of raw organic vegetable salad as breakfast. Coconut oil has powerful anti-viral and anti-fungal properties - Lauric acid and capric acid is present in coconut oil will be part of the adipose tissue for growing fetus and also it helps milk store of a lactating mother in the later stage. It will also boost up your immune system and thus, your growing baby will be free from fungal and inflected viruses as well.

Calcium is used to build a baby's bones and teeth. It’s very much essential to have calcium in your diet, if you do not consume enough calcium, the mineral will be drawn from the mother's stores in her bones and given to the baby to meet the ultimatum of pregnancy. Dairy products are also strengthened with vitamin D, this nutrient also plays a vital role with calcium in the progress of a baby's bones and teeth.

Enough Protein is needed for would-be mother, most women don't have problems getting enough protein-rich foods in their diets. Still, I will recommend that it’s better to consult your gynecologist for which kind of protein intake is suitable for you. Pregnant lady should include protein-rich foods such as meat, poultry, fish, dried beans and peas, eggs, nuts, tofu.

Eat fruits like raspberries, blueberries, and strawberries are very good and tasty as well. They're stocked with phytonutrients -- plant compounds that help fight disease. It contains lots of vitamin C, which is mandatory for proper collagen formation, it’s an opener to strengthening your membranes.low in vitamin C in your diet may increase the risk of premature delivery. In your breakfast, have a Plate full of berries and layer them with yogurt and high-fiber lentils.

Apart from taking healthy nutrients, pre-pregnant women should maintain a healthy lifestyle as well.

Stress can inflict havoc on your body by boosting diabetes levels also can affect I’m blood pressure which can suppress ovulation and decrease sperm count. Stress can stagnate energy and constrict blood flow. This stuff can help you manage your stress. Again I mention before doing all these do consult your physician positively.

Breathing exercises

Meditation

Hot oil massage on hair

Proper Sleep

Acupressure

Reading Journals

Listening light music,

Take a relaxing bath

What you shouldn’t intake during pregnancy or if you are planning for it.

Forgot intake of alcohol if you are planning to conceive, during pregnancy, and till breastfeeding. Drinking alcohol during pregnancy causes(FAS) fetal alcohol syndrome.

Stop consuming foods which lead to food poisoning or other disease caused by bacteria. These include everyone's choice like soft cheeses, paté, cold meats, pre-prepared salads, raw or smoky seafood, and raw eggs. Make sure that eggs, meat, and fish you eat are cooked properly and should be fresh not like buying from the market yesterday and cooking day after that.

Choose fresh fish. Some fish carry out more amount of mercury than others. Like if you want to eat Canned tuna which is very much affordable and also full of omega-3s. You can serve this 2 Or 3 in week. Here is some list of fish you can have while pregnant in your pre-pregnant period. Like- Shrimps, Salmon, Catfish, crab, etc.

Never ever skip breakfast rather you should have proper nutritional breakfast during this time.If you can cut off caffeine that’s well and good Or just keep your caffeine consumption to a maximum of 200 mg per day.Don’t forget caffeine is also in chocolate, tea, some soft and energy drinks too. Don’t take prot5 shake without prescribed by your physician.

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