Frequently Asked Questions

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.

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 30 day cycle).

There is no relation between blood groups and fertility.

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!

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.

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!

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.

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.

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 infertiliity, it's the infertility which causes the stress!

Many pelvic infections have no symptoms at all, but can cause damage, sometimes irreversibly, to the tubes.

Fact: 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.

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.

There is no correlation between male fertility and virility. Men with totally normal sex drives may have no sperms at all.

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.

The doctor will individualize your case after looking at your previous history and data from the other clinics and will tailor-make a protocol and plan that will increase the chances for a successful pregnancy.

Yes, we can perform a procedure called TESA, which stands for Testicular Sperm Aspiration and it refers to the procedures used to obtain viable sperm from the male reproductive tract. This procedure is used to treat male infertility due to absence of or extremely low sperm count in the male ejaculate. TESA involves a small needle biopsy of the testicle. This is done as an office procedure using sedation. A very fine needle is gently inserted into the testicle to obtain a small amount of tissue. The sperm sample collected will later be used with IVF-ICSI (in vitro fertilization with Intra-cytoplasmic Sperm Injection) in order to increase the chances of conception. Men with any kind of sperm problems are not good candidates for intrauterine insemination (IUI) because there are usually not enough sperm retrieved to perform this treatment, and therefore we always use IVF with ICSI.

To date there have been no studies that can fully answer that question with a yes or no. With Natural Cycle IVF, an embryo is placed directly inside the uterus. With IUI, sperm that is placed inside the uterus must then travel to the upper reproductive track on its own, meet the egg, hopefully fertilize and then implant in the uterus. Based on this, Natural Cycle IVF may be a better option when compared with IUI.

• Patients who prefer not to take any hormone injections
• Patients who are afraid of needles
• Patients who are over 35
• Patients who do not respond well to stimulation
• Patients who have a history of breast or ovarian cancer
• Patients who had many failed IVF cycles
• Patients who cannot afford the high cost of IVF medications
• Patients who are unable to come for daily monitoring needed for conventional IVF

PGD (Preimplantation Genetic Diagnosis) technology improves the likelihood of a successful pregnancy and birth for two distinctly different groups of patients. Couples with infertility related to recurrent miscarriage or unsuccessful IVF cycles and couples who are at risk for passing on inherited genetic disease to their offspring. Following ovarian stimulation , egg collection and fertilization, embryos are cultured for another 2 -3 days which they usually consist of 6-8 cells or more . Each of these cells has complete genetic information and also each cell has the potential to continue growth to establish pregnancy. Therefore, one or two cells can be removed from an 8-cells embryo by using an embryo biopsy procedure and the embryo will continue to develop normally. The removed cells will then be analyzed by using a technique called Fluorescent in situ Hybridization ( FISH ) or Polymerase Chain Reachion ( PCR ). The FISH technique can tell us whether an embryo cell has two X chromosomes ( female ) or one X and one Y chromosome ( male ) and FISH can also be used to detect specific chromosome problems such as Down syndrome. FISH analysis can give us the results within one day and the resulting normal embryos will be transferred back into the uterus. This technique is now suitable for specific couples such as advanced maternal age who have a very high risk to have a child with Down syndrome , carriers of genetic disease , recurrent abortion and couples who carry X-linked diseases. Haemophilia and Muscular dystrophy are examples of X-linked diseases. In the future it is likely that genetic testing of embryos will be used more routinely to improve IVF success rates as well as to prevent transmission of genetic disease. With the transfer of genetically normal embryos, a higher percentage of implantation and reduced miscarriage rates can be expected. This sophisticated and technologically advanced testing identifies which embryos are free of abnormalities and more able to achieve the patient's goal of a healthy baby. PGD is recommended for families with a history of a specific genetic disease. Using polymerase chain reaction, fluorescent PCR and DNA sequencing, the scientists can examine each developing embryo to identify the absence or presence of these specific genetic disorders. As a result, only those embryos free of genetic disease will be transferred to the patient’s uterus so as to increase the chance of conception and ultimately a healthy baby. Single gene disorders are categorized depending upon whether the gene is located on the X chromosome, an autosome or whether the gene is dominant or recessive. These classifications include autosomal recessive, autosomal dominant and X-linked. For a dominant disorder, one only needs to have the abnormal DNA sequence on one chromosome. If that mutation is passed on to the embryo, the embryo will be affected with that genetic disease. One example of an autosomal dominant disorder is Myotonic dystrophy. Recessive disorders require that the mutation be present on both chromosomes of the chromosome pair. If one only has the mutation on one chromosome, the individual is normal but carries the mutation in his cells and is called a carrier. The fertilization of an egg from carrier parents may result in an embryo having the mutation on both chromosomes of the chromosome pair and the embryo therefore being affected with that genetic disease. For example, Cystic fibrosis (CF) is a common autosomal recessive genetic disorder that primarily affects the lungs of CF patients. The CF mutation affects a protein within the cell that reduces the cell's ability to function properly. This results in a build up of mucous within the lungs, lung dysfunction and possible death. X-linked disorders are due to mutations of genes on the X chromosome and have different patterns of inheritance due to their transmission on a sex chromosome and whether the embryo is male or female. Examples of X-linked diseases are the Fragile X syndrome and Duchenne muscular dystrophy.

Pre-implantation Genetic Diagnosis (PGD), also known as “embryo screening”, is the application of genetic testing on cells obtained from an embryo to determine the presence, absence or change in a specific gene prior to transferring the embryo into the womb. Only the healthy embryos are transferred to the uterus to guarantee a pregnancy of a baby that is free of the genetic disorder.

Single gene disorders are genetic conditions caused by the alteration or mutation of a specific gene. They are hereditary and therefore individuals with a family history of a single gene disorder may pass the condition onto their children. Some of the most common single-gene disorders include Beta-thalassemia, Sickle Cell Anemia, Spinal muscular atrophy and Metabolic disorders to name a few.
Curing a child suffering from a genetic disorder Families who have a child suffering from a genetic disorder can cure this child by bone marrow transplant (BMT) (hemoglobinopathies). The method offers PGD coupled with HLA matching. The selected embryos during PGD will be normal and HLA matching with the affected sibling. And once the healthy baby is born, he/she can cure the other child via a bone marrow transplant. It is worth noting that the success rate of curing an affected child by this method could reach over 85%.
-A list of all the single gene disorders that can be identified. Any single gene disorder not listed could be accepted for screening if the gene causing the disease is known. Any single gene disorder with a known mutation could be accepted for PGD. This could be down in collaboration with overseas centers.

• Achondroplasia
• Adenosine Deaminase Deficiency
• Adrenal Hyperplasia
• Alagille syndrome
• Albinism
• Alpha Thalassemia
• Ataxia Telangiectasia
• Auto-immune Lymphoproliferative syndrome
• Beckwith-Wiedemann syndrome
• Beta-Thalassemia, Sickle Cell Anemia
• Bilateral Lebers Congenital Amaurosis
• Biotinidase Deficiency
• Blindness (Usher syndrome)
• Brachydactyly Type B
• CADASIL
• Carbohydrate-Deficient Glycoprotein syndrome, Type I
• Charcot-Marie-Tooth disease
• Congenital Adrenal Hyperplasia (CAH)
• Congenital Cholestasis
• Congenital Analgesia syndrome
• Congenital Disorder of Glycosylation
• Congenital Ichthyosis
• Congenital Myotonia
• Congenital Nephrotic syndrome
• Crigler Najjar syndrome ,
• Cystic Fibrosis
• Deafness (Connexin 26)
• Duchenne/Becker Muscular Dystrophy (DBMD)
• Ehlers–Danlos Syndrome (EDS) or "Cutis Hyperelastica”
• Epidermolysis Bullosa
• Fabry Disease (also Fabry’s Disease or Anderson-Fabry disease)
• Familial Juvenile Nephrophthisis
• Familial Mediterranean fever (FMF)
• Fanconi Anemia
• Fragile X syndrome
• Friedreich Ataxia
• Fructose 1,6-bisphosphate (also known as Harden-youngester)
• Glucose 6 Phosphate Dehydrogenase
• Gaucher disease
• Glutaric Aciduria type 1,2,3
• Glycosyl Decarboxylase (GLDC, AMH)
• Hemochromatosis
• Hemophilia
• Hereditary Spastic Paraparesis (HSP) or the Strümpell-Lorrain
• syndrome
• Hurler–Scheie syndrome (also known as "Mucopolysaccharidosis type I H-S”
• Hurler syndrome (Type 1)
• Hyperoxaluria
• Ichthyosis
• Infantile Polycystic Kidney disease
• Insulin-Dependent Diabetes Mellitus (Type 1 diabetes mellitus)
• Isovaleric academia
• Joubert syndrome
• K-Ras Mutation screening
• Lamellar ichthyosis
• Leukodystrophy
• Leukocyte Adhesion syndrome
• Lipoprotein lipase syndrome
• Maple Syrup Urine disease
• Marfan syndrome
• Maturity-onset diabetes of the young
• Meckel-Gruber syndrome
• Medium Chain acyl CoA Dehydrogenase
• Methylenetetrahydrofolate reductase (MTHFR)
• Methylmalonic Acidemia
• Mitochondrial genome screening
• Mucopolysaccharidosis TYPE I
• Mucopolysaccharidosis-Type III
• Mucopolysaccharidosis-Type IV
• Mucopolysaccharidosis-Type VI
• Multiple Acyl-CoA Dehydrogenase Deficiency (MADD)
• Multiple Endocrine Neoplasia-Type1
• Neiman-pick Type B
• Neonatal Cholestasis
• Neurofibromatosis
• Neuronal Ceroid Lipofuscinoses (NCL)
• Nevoid Basal Cell Carcinoma syndrome
• Non Polyposis Colon Cancer
• Non-Insulin Dependent Diabetes
• Noonan syndrome
• Omenn syndrome
• Ornithine transcarbamylase deficiency (OTCD)
• Osteogenesis Imperfecta
• Osteopetrosis
• Peroxisome biogenesis disorder
• Perforin
• Phenylketonuria
• Polycythemia Vera
• Pompe disease
• Prader-Willi syndrome
• Primary Dystonia
• Propionic Aciduria
• Pseudohypoparathyroidism
• Retinitis Pigmentaria
• Rett syndrome
• Sandhoff disease
• Sanjad-Sakati syndrome (SSS)
• Seckel syndrome
• Short Chain acyl CoA Dehydrogenase
• Sickle Cell Anemia
• Skeletal Dysplasia
• Smith-Lemli-Opitz syndrome (SLOS)
• Spina Bifida (or Myelomeningocele)
• Spinal Muscular Atrophy
• Thanatophoric Dysplasia
• Thrombocytopenia (or Thrombopenia)
• Tuberous Sclerosis
• Very Long Chain acyl CoA Dehydrogenase
• Vitamin D Receptors
• Wilson disease
• X-Linked Deafness
• X-linked thrombocytopenia
• Y-chromosome Micro Deletion