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Sperm Problems- IUI or IVF- What to do?
Often we see men are coming to us with abnormal semen analysis report showing very low ("Oligospermia") or absent ("Azoospermia") sperm count or very poor "motility" (ability to move) of the sperms. Naturally, they are very much worried and want to know whether medicines can be helpful.

Two things must be remembered

1) Semen Report must be REPEATED from an AUTHENTIC LABORATORY after ABSTINENCE of 3-5 days. This is important, as the sperm count varies day to day. It takes almost 3 months to produce the sperms. therefore, if today you wear very tight underwear or you have high fever, your sperm count (checked after 3 months from today) will be low. As a result, a SINGLE ABNORMAL SEMEN ANALYSIS report does NOT HAVE ANY SIGNIFICANCE. You need to repeat it.

2) Both Male and Woman should be seen together. What treatment is required, actually depends on the reports of both the partners, their age and duration of infertility. Moreover, the pregnancy will ultimately happen on the woman. That's why, we need to see both together.

Unfortunately, in many of such cases, medicines cannot work. Still, you can become biological father using your own sperms. Initially you can take medicines. but even after taking medicines, sperm counts remain abnormal, you should consider IUI or IVF.

What is IUI (Intrauterine Insemination)?
Medicines (tablets, injection) are given to your wife to help her eggs grow. By ultrasound, we see whether eggs are growing. If the eggs about to rupture, husband’s sperm is collected, processed (“preparation”) and then inserted inside the uterus. The success rate is 10-15% per cycle. That means out of 100 couples trying IUI, 10-15 can conceive after the first cycle. You can try maximum 3-4 cycles of IUI.

When IUI can be done?
If the sperm count is mildly/ moderately low, IUI can be tried. However, for doing IUI, at least one fallopian tube of your wife MUST be open. Moreover, the success rate of IUI is hiogher if your wife's age is less than 35 years, she is having good number of eggs in the ovaries and you are not trying for pregnancy for long time.

What is IVF (in vitro fertilization)?
Your wife will be given some injection (gonadotrophin) to promote growth of the follicles (fluid filled sacs in the ovaries containing eggs). Injections are NOT painful and are needed to be taken under the skin. She has to come to TVS (ultrasound by putting probe in the vagina) follicular study regularly to see if the follicles are growing. Usualy, injections are needed for 10-12 days. After that, under anaesthesia, eggs are collected from her body by inserting small needle. The eggs are then fertilized with the sperm to produce the embryos. The embryos are then transferred after 2-3 days (Fresh Transfer) or after 2-3 months (Frozen Transfer). The success rate of IVF is 40-50%. That means out of 100 couples undergoing IVF, 40-50 can conceive after the first cycle.

When IVF should be done?
If you have tried IUI for 3-4 cycles and failed, you should consider IVF. If your wife's fallopian tubes are blocked, her age is on the higher side, she is having less number of eggs in the ovaries and you have been trying for pregnancy for longer time, you should NOT delay IVF.

What to do if the sperm count is severely low?
In that case, you require a special type of IVF, called ICSI (Intracytoplasmic Sperm Injection). Here, the sperms collected from you, will directly be injected inside the eggs collected from your wife to form the embryo. It increases the success rate.

Whether IUI or IVF/ ICSI will be done using your sperms or donor sperms?
We always encourage the couples to become biological parents. Therefore, we always prefer using your own sperms. Donor sperms are used for IUI ONLY when your sperm count is very low, you require IVF-ICSI but unfortunately you cannot afford. Donor sperms can ONLY be used after taking consent from BOTH the husband and the wife.

What to do if there is no sperm (Azoospermia)?
There is also no need to use donor sperms. You can father your own baby using your own sperms, collected from your testicles, by small needle (TESA- Testicular Sperm Aspiration). Those sperms can be used for ICSI.

In most of the case, you can become biological father of your own baby using your own sperms by IUI or IVF. If the problem is mild, IUI can be tried. In case of severe problem, you should not delay IVF. Donor sperm is not usually needed.

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