S. R. Multi Speciality Hospital

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Common infertility problems
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Patient counselling
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Pre-Procedural Requirements

Initial Consultation - Doctors and Staff Introduction for Infertility.

1. Fertility specialist also known as reproductive endocrinologist, lead infertility treatments.

  • The process typically begins with scheduling an initial appointment with a fertility specialist.
  • During this appointment, the specialist will review your medical history, including any previous pregnancies, medical conditions, surgeries, medications, and lifestyle factors that may impact fertility.

2. Embryologists handle fertilization and embryo culture in IVF.

  • Embryologists play a crucial role in infertility treatments.
  • Responsible for performing the fertilization process in the laboratory such as in vitro fertilization (IVF) and other assisted reproductive technologies (ART) and in educating patients about the IVF process, including embryo development, treatment options, and expectations.
  • They provide support and guidance to patients throughout the treatment cycle, addressing their questions, concerns, and emotional needs related to infertility treatment.

 

3. Nurses and medical assistants provide crucial support throughout the process.

  • From initial consultations to treatment procedures and follow-up care, nurses and medical assistants provide compassionate care and practical assistance to patients navigating the complexities of infertility treatment.
  • They often serve as the primary point of contact for patients, offering emotional support, answering questions, and addressing concerns at every stage of the journey.
  • They will assist in various aspects of infertility treatment, including scheduling appointments, coordinating diagnostic tests, administering medications, and providing instructions for treatment protocols

Diagnostic Testing

Following the initial consultation, the fertility specialist may recommend diagnostic tests to assess fertility potential for both partners.

This may include, For

  1. Wife: Blood tests (such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) to assess hormone levels, ultrasound to evaluate ovarian reserve, uterus and ovaries, hysterosalpingogram to check fallopian tube patency etc. anything if required.

 

  1. Husband: Semen analysis to assess sperm count, motility, and morphology. DFI – to analyse the sperm DNA integrity, scrotal scan and testicular biopsy if required.

Treatment Plan

  1. Based on the results of diagnostic tests and individual circumstances, the fertility specialist will discuss treatment options tailored to your specific needs.

 

  • Treatment options may include lifestyle modifications.
  • Ovulation induction with medication.
  • Intrauterine insemination (IUI).
  • In vitro fertilization (IVF), Intracytoplasmic sperm injection (ICSI).
  • Preimplantation genetic testing (PGT).
  • Donor gamete/sperm options, depending on the diagnosis and prognosis.
  1. Once a treatment plan is agreed upon, the fertility specialist will provide detailed information about the chosen treatment, including the procedures involved, medications required, timeline, potential risks, and expected outcomes.
  2. Patients will also receive guidance on medication administration, monitoring appointments, and lifestyle recommendations to optimize treatment success.

No of visits

  1. Patients undergoing IUI may require 3-4 visits for monitoring and the procedure itself.
  2. IVF patients usually visit the hospital 8-10 times for monitoring, retrieval, transfer, and follow-up appointments.

Time Taken for Complete Procedures of IUI and IVF

  1. IUI (Intrauterine Insemination): Typically takes about 2-3 weeks from ovarian stimulation to insemination.
  2. IVF (In Vitro Fertilization): The entire process spans approximately 2-4 months, including preparation time (1-3 months – depending upon the cause), ovarian stimulation and egg retrieval (15 days), fertilization, embryo culture, and transfer (15-20 days if it occurs in the same cycle, again the schedule of embryo transfer depends upon the cause).

Common Side Effects and Adverse Reactions for Drugs Used

1.Ovarian Stimulation Drugs: Common side effects include bloating, mood swings, and hot flashes.

2.Gonadotropins: Increased risk of ovarian hyperstimulation syndrome (OHSS) in some cases.

3.Progesterone: Side effects may include fatigue, breast tenderness, and mood changes.

4.Gonadotropin-releasing hormone agonists/antagonists: Possible side effects include headaches, nausea, and injection site reactions.

Success Rates – Worldwide vs Our SR Hospital

  1. Worldwide IUI success rates range from 10-20%, depending on factors like age and fertility issues and our centre is also follows the same.
  2. IVF success rates vary widely but are generally higher, our centre is giving results with an average success rate of around 45% for women under 35, whereas 35% is the worldwide success rate.

Budget and Cost for Investigations, Medicines, and Procedures

  1. Investigations: Costs vary but can range from a few hundred to a few thousand, depending on the tests required (rs8,000-9,000 – based on the individual)
  2. Medicines: Ovarian stimulation medications for IVF can cost several thousand (40-60k) per cycle.
  3. Procedures: Costs for IUI ranges from rs7000 – rs12000 per cycle, while IVF costs rs1,50,000-2,00,000 per cycle (depends upon each individual) which includes consultations, diagnostic tests, ultrasound scans, medicines, injections, OT and room charges.

Financial Considerations

  1. Fertility treatment can be costly, and patients should discuss financial considerations, including treatment costs, insurance coverage, and payment options, with their fertility specialist and financial counsellor.
  2. Understanding the financial aspects of treatment can help patients make informed decisions and alleviate some of the financial stress associated with fertility treatment.

Emotional Support and Counselling

  1. Fertility treatment can be emotionally challenging, and it’s essential for patients to receive emotional support and counselling throughout the process.
  2. Fertility specialists and their teams often provide resources for emotional support, including counselling services, support groups, and educational materials to help patients cope with the stress and uncertainty associated with infertility treatment.

Post-Procedural Factors

If the Treatment Result Becomes Positive

1. Celebrate and Embrace the Moment

   – Take time to celebrate this significant milestone and acknowledge the emotional journey you’ve been through to reach this point.

2. Notify Your Fertility Clinic

– Inform your fertility clinic immediately about the positive pregnancy test result. Will guide you on next steps and schedule follow-up appointments for monitoring.

3. Continue Medications as Prescribed

– Follow your fertility specialist’s instructions regarding medications. In many cases, hormone supplements or medications may need to be continued to support the pregnancy during the early stages.

4. Attend Follow-Up Monitoring Appointments

– Attend all scheduled follow-up appointments for blood tests and ultrasound scans to monitor the progress of the pregnancy and ensure everything is developing as expected.

5. Maintain Healthy Lifestyle Habits

   – Continue to prioritize a healthy lifestyle by eating nutritious foods, staying hydrated, getting regular exercise (as advised by your healthcare provider), and avoiding harmful substances such as alcohol, tobacco, and recreational drugs.

6. Manage Stress and Anxiety

While it’s natural to feel excited and anxious, try to manage stress levels by practicing relaxation techniques, mindfulness, and seeking support from loved ones or counselling if needed.

7. Educate Yourself About Pregnancy

Take the time to educate yourself about the stages of pregnancy, prenatal care, and what to expect during the upcoming months.

8. Communicate Openly with Your Partner

– Maintain open communication with your partner throughout the pregnancy journey. Share your thoughts, fears, and hopes, and support each other emotionally and physically.

9. Establish Prenatal Care with an Obstetrician

Begin prenatal care with an obstetrician who specializes in high-risk pregnancies, especially if you have underlying medical conditions or if the pregnancy is considered high-risk due to factors such as advanced maternal age or previous pregnancy complications.

10. Stay Positive and Hopeful

Remain optimistic and hopeful while understanding that pregnancy can bring unexpected challenges. Surround yourself with a supportive network of family and friends who can offer encouragement and assistance along the way.

By following these important points and seeking appropriate care and support, you can navigate the early stages of pregnancy with confidence and optimism, laying the foundation for a healthy and fulfilling journey into parenthood

If the Treatment Result Becomes Negative

Experiencing a negative result after IVF treatment can be emotionally challenging.

1. Allow Yourself to Grieve and Process Emotions

– Journaling or expressing your feelings through creative outlets like art or music can also be therapeutic.

– Recognize that everyone copes with grief differently, and it’s okay to seek professional help if you’re struggling to manage your emotions.

2. Communicate with Your Partner

– Schedule regular check-ins with your partner to discuss how you’re both feeling and how you can support each other moving forward.

– Consider attending counselling sessions together to strengthen your communication and coping strategies as a couple.

3. Seek Guidance from Your Fertility Clinic

– Ask your fertility specialist about any additional tests or evaluations that may provide insights into potential reasons for the negative outcome.

– Inquire about alternative treatment options or protocols that may be recommended based on your specific circumstances.

 

4. Review and Understand the Treatment Cycle

– Request a detailed review of your treatment cycle from your fertility clinic, including any observations or findings that may inform future decisions.

– Take notes during your appointment and ask for clarification if there are aspects of the treatment protocol that you don’t fully understand.

5. Discuss Alternative Treatment Options

– Explore holistic or integrative approaches to fertility care, such as nutrition, counselling or stress reduction techniques.

– Research complementary therapies that may support reproductive health and overall well-being, but consult with your healthcare provider before making any significant changes to your regimen.

6. Focus on Self-Care

– Create a self-care routine that incorporates activities you enjoy and that promote relaxation and stress relief.

– Consider incorporating mindfulness practices such as deep breathing exercises, meditation, or yoga (Meditation and yoga classes available in our hospital, Monday – Thursday – 12:30 pm – 1:30 pm) into your daily routine to help manage stress and anxiety.

7. Connect with Support Groups

– You can connect with others who have undergone similar experiences, shared insights, and provide mutual support.

– You can communicate with other patients who have achieved positive outcomes after IUI or IVF treatment in our hospital, fostering hope and optimism.

8. Consider Counselling or Therapy

– Explore different therapy modalities, such as cognitive-behavioural therapy (CBT), dialectical behaviour therapy (DBT), or acceptance and commitment therapy (ACT), to find an approach that resonates with you.
– Be open to exploring past experiences or underlying issues that may be impacting your emotional well-being and fertility journey.

9. Evaluate Future Treatment Plans

– Take time to research and consider all available treatment options, including alternative therapies, donor options, adoption, or remaining childfree.

– Consult with fertility specialist to get perspectives and treatment recommendations before making a decision.

10. Stay Hopeful and Open-Minded

– Practice gratitude and focus on the positive aspects of your life and relationships outside of infertility.

– Allow yourself to envision different paths to parenthood and embrace the possibility of unexpected opportunities or outcomes along your journey. By taking proactive steps to address emotional needs, seek support, and evaluate future options, you can navigate the challenges of infertility with resilience and determination, empower yourselves to make informed decisions about your fertility journey.

Psychological Factors

How to manage Stress and Family Pressure

  1. Therapeutic Communication: Provide a safe space for you to express your feelings and concerns about infertility and familial pressures.
    Dealing with Relationship Challenges: Address communication difficulties, conflict resolution, and intimacy issues that may arise between partners during infertility treatment.
  1. Cognitive Behavioural Therapy (CBT): Recognize and challenge negative thought patterns related to infertility and family expectations.
  1. Stress Reduction Techniques: Undergoing relaxation techniques such as deep breathing, progressive muscle relaxation, and mindfulness meditation to cope with stress.
  2. Support Groups: Encourage yourself in participating support groups where you can connect with other patient’s experiencing similar challenges, share experiences, and receive validation and support.

Some of the stress Management Methods

  1. Mindfulness and Meditation: Practicing mindfulness techniques and meditation to promote relaxation and reduce stress levels. (Meditation and yoga classes available in our hospital – Monday to Thursday – 12:30 pm – 1:30 pm)
  2. Physical Activity: Engaging in regular exercise such as yoga, swimming, or walking to release endorphins and alleviate stress.
  3. Music Therapy: Listening to calming music or engaging in musical activities as a form of self-expression and relaxation.
  4. Medication: In some cases, prescribed medication may be used to manage anxiety or depression associated with infertility treatment.

Acknowledging Losses and Facilitating Grief

  1. Validation of Emotions: Acknowledging the losses and emotional pain associated with infertility and unfulfilled expectations.
  2. Encouraging Expression: Provide opportunities to express your grief through journaling, art therapy, or support group discussions in order to normalize grief reactions.
  3. Exploring Meaning-Making: Finding the meaning and purpose in your journey, explore alternative paths to parenthood.

Acceptance of Problems and Moving Forward

  1. Psychoeducation: Educating about the medical aspects of infertility and the available treatment options to empower you to make informed decisions.
  2. Exploring Values and Priorities: We are here to encourage you to reflect on your values and priorities in life, including the desire for parenthood and the potential impact of infertility on your overall well-being.
  3. Goal Setting: Collaborate with your friends (who is undergoing the same treatments over here in our hospital) to set realistic goals and develop adaptive coping strategies to navigate the challenges of infertility treatment.

Decision-Making Process

  1. Informed Consent: Ensuring you have access to comprehensive information about treatment options, including their risks, benefits, and alternatives.
  2. Shared Decision-Making: Facilitating open communication between you and us to explore treatment preferences, values, and concerns.
  1. Exploring Personal Values: Encouraging you to reflect on your personal values, beliefs, and priorities in making decisions about fertility treatment.
  2. Seeking Support: Will provide resources and support to help you to navigate the decision-making process, including access to counselling, peer support groups.

Some of the other factors

– Body Image and Self-Esteem: Supporting you in coping with body image concerns, self-esteem issues, and feelings of inadequacy related to infertility.

– Cultural and Religious Beliefs: Recognizing the impact of cultural and religious beliefs of your experiences of infertility and addressing any conflicts or tensions that may arise.

– Fertility Preservation and Family Planning: Provide counselling and guidance on fertility preservation options for you and your partner facing medical treatments that may affect your fertility, as well as discussing alternative family-building options such as surrogacy.