IUI , ICSI , IVF Clinics in Bangalore for assisted reproduction

Bangalore (India) is becoming an emerging destination for assisted reproduction procedures. An IVF cycle can be carried out at almost 1/10th of the cost as compared to a typical hospital in US.

The prices are (as quoted to us), during the month of June 2014, and includes all charges.

The charges vary across different centers mainly depending on the pre and post operating procedures in a typical IVF/IUI cycle.

Some specialists operate across multiple hospitals/clinics, and even for the same IVF/IUI specialist, the cost can vary a lot. I have observed prices are almost 50 % lower in smaller clinics, but price should not be criteria for selection, the doctor and the facilities should stand first. My Pregnancy story , on why pregnancy is not just a successful IUI, IVF or ICSI, but much beyond that. It's a start of a long journey.

In Random Order (All Inclusive cost of procedures across Bangalore hospitals updated :)

List of IVF Centers in Bangalore:

1. Milann - [ Formerly BAAC (Bangalore Assisted Conception Center.) ]

IUI Cost = 17000, IVF Cost = 1.35 Lakh.
Consultation Cost : 1000 Rs.

Dr. Kamini A. Rao ( Medical Director )  is one of the senior most fertility specialists in Bangalore. She is one of the few doctors in India and the only one from Bangalore currently involved in drafting a bill for improving assisted reproductive procedures in India.

2. ManipalAnkur [ Merger of Manipal Hospital and Dr Vasan's Ankur Fertility ]

IUI Cost = 15000, IVF Cost = 1.25 Lakhs, ICSI Cost = 1.6 Lakhs, Sperm test = 600 Rs, Sperm test including DFI = 2000 Rs.

Doctors in Manipal = Doctor Beena Vasan and Doctor Jyothi Menon for female infertility, Doctor Vasan SS for male infertility.

Dr. Vasan is also HOD of Manipal IVF Department and along with her wife Beena Vasan, also runs an infertility clinic called Ankur fertility.

3. Sure Fertility

(HSG test cost = 5000), IUI Cost = 6000, IVF Cost = 60,000, ICSI Cost = 70,000

All these costs are exclusive of follicular, pelvic scans, medicines. Treatment duration 1 cycle (30 days only)

Dr Jyothi Menon, Dr Rupa for female infertility. More about sure fertility

4. Morpheus Indo-German Fertility Centre ( Jaynagar )
Dr. Biraj Kalyan

Preliminary Test Cost : 11000 INR [ 1 Reader reported ] ( Second Cycle Free Offer )
IVF Cost = 90000 INR + Drugs 
ICSI Cost = 100000 INR + Drugs


Well this we found very interesting. It translates to 2 IVF cycles for INR 90000 , that makes it the most affordable in Bangalore.

(Without the offer / Per Cycle cost )
IVF Cost  = 65000 INR + Drugs
ICSI Cost = 75000 INR + Drugs
They seem to have 4 branches in Bangalore. The major Centre is Jaynagar itself.
Have presence in 13 cities all across India. 
Well what more.... personal loans available in their brochures.

5. Gunasheela IVF Centre , Basavangudi

Dr Devika and Dr Sulochana Gunasheela
Dr Jyothi Menon - Heavy Rush reported. Long Queues. Hygiene issues in clinic.

IUI Cost = 8000 Rs, IVF Cost = 85,000 Rs, ICSI Cost = 90,000 Rs.

6. Dr Patil's Fertility & Endoscopy Clinic

Dr. Madhuri Patil (for female infertility).

IUI Cost = 10000 Rs ( up 100% in 2 yrs ) , IVF Cost = 150,000 ( up 50 % in 2 yrs ) Rs, ICSI Cost = 1,60,000 Rs. ( up 40 % in 2 yrs )

7. Garbha gudi IVF centre, Banashankari
Dr. Asha S.Vijay and Dr. Hari

IUI Cost = 11000 Rs. to 16000 Rs.

IVF Cost =  1.5 lakhs to 2 lakhs Rs.

ICSI Cost = 1.7 lakhs to 2.2 lakhs Rs.

8. GIFT Gyno IVF centre , Indiranagar and Marathalli
( We thank you for the transparency in charges )

Dr. S.Mani and Dr. Anita Mani

IVF :  50,000 INR + Medication Charges
Revised March 2014
IVF: 1.4 Lakhs to 1.6 Lakhs [ Ref: www.giftivf.com ]

9. Kamini Rao Hospital

Dr Kamini Rao of BAAC as mentioned in #1 above.

They do conduct IUI’s, but couldn't get any updates for the cost involved.

10. Manipal North side hospital  Now Milann [ Point 2 above ]

Dr. Nandini Devi and Dr Beena Vasan

11. Ankur fertility  Now Milann [ Point 2 above ]

Dr. Malathi Rao and Dr Beena Vasan

12. NOVA IVI 
Dr. Manjunath  C S
NOVA Pulse IVF clinic is about to open an infertility specialist clinic in Bangalore. There are also talks of a foreign medical chain buying stake in NOVA IVF

[ Update Oct 2017 ] They have 3 locations now in Bangalore:
Bangalore - KAMMANAHALLI  - Dr. Pallavi Prasad
Bangalore - KORAMANGALA - Dr. Mahesh Koregol  Dr. Rashmi Yogish

Bangalore - SADASHIVANAGAR - Dr. Aviva Pinto Rodrigues  Dr. Santosh Gupta

ICSI Cost - 1.67 Lakhs Rs. [ 4 Readers Average ] , IVF Cost - 1.15 Lakhs per cycle

. This is one of the highly professional hospitals focusing on only 3 I's i.e. IUI, IVF and ICSI.

13. CREATION (FORTIS HOSPITAL)

We came to know about CREATION, somewhat late, until few of the readers had specific queries about some of the doctors there.

FORTIS, in Bangalore, by way of their specialty infertility center called CREATION, have made a huge investment in promoting the same.

 We tried to get details of their pricing model for IVF, IUI, and ICSI. There was a 200 % variance in the price of what FORTIS quoted for IUI and IVF as compared to the actual costs incurred (as discussed with few patients). Anyways, we know with FORTIS standards (and the kind of investment they have made in this infertility centre) this was always expected to be very high, with one patient reporting it to be upward of 15000 Rs per IUI cycle, exclusive of medicines and tests. 

The price for IVF, including hospital stay will fall around 1.4 Lakhs Rs (exclusive of medicines and tests)

They do have a dedicated site for fertility. Looks impressive first time, having some general articles projecting the infertility scene, some high profile doctors, few interesting testimonials, and of course the Android App. Definitely high profile advertising to gain more market share in Bangalore.

14. Shubha Ayurvedic center ( Reported by readers )
Phone no:08026578620
South End circle Jayanagar.
Dr Shubhankari Rao and Dr Padmanabh Rao.

15. Momsoon Fertility & I.V.F. Centre ( Jaynagar )
Dr. Y. Ravindranath, Ph.D (Human Genetics) - Senior Embryologist & Scientific Director.



16. Cherish Centre for reproductive medicine ( Koramangala )
Has a smaller known unit also Bellevue's Cambridge Infertility & IVF Centre ( Ulsoor )
Dr. S.K.SreeKumar

17. Cloud Fertility  ( J.P. Nagar, Malleshwaram , Old airport Road , Jayanagar , Whitefield , Bellandur )
Dr, Manju Nair
Dr. Reeta Biliangady
Dr. Indu Gopal
Dr. Sumana Gurunath
Dr. Uma Maheshwari
Dr. Basavaraj Devarashetty
Dr. Mamatha . J

My Pregnancy Story

The Bangalore Infertility Scene:

With the proliferation of so many new centers and major hospitals expanding their foray into this highly lucrative and profitable vertical, there has been no decrease in prices. They have constantly gone upwards by an average of 20-25% every year. There is no regulatory legislation to govern these clinics in India. The demand is ever increasing due to more and more young people getting married and finding it hard to go to next stage of family. Well one can always say that IT/ITES does not give you chance to lead a healthy lifestyle , but do not forget that it’s not just in Bangalore , but the trend is visible across India.

It is not a lifestyle disorder, but the decrease in fertility rates is a country wide phenomenon. We just happen to be in Bangalore where we are just a bit more expressive and vocal on internet, as compared to other towns. Add to it, the vicious IT tag, people are supposed to always pay a premium, whether it’s in hospital or school, travel agents or whatever.

The infertility centers (except in one case) do not advertise their rates. The reason might be that they do not want to lose the flexibility in deciding the clinical charges on demand. There is a race between the fertility clinics to get the most rated doctors in their hospitals.

Our readers don’t want fancy statistics from all those 5 star hospitals.

Our questions and expectations are fairly straight.

1.     How many successful and unsuccessful procedures you do? (Describing success in IUI, IVF or ICSI in terms of % is a very elusive.)

2.     What are the possible side effects one can have while undergoing these procedures?

3.     What are the assurances regarding the quality of donor eggs and donor sperms?

4.     How many pregnancies resulting in miscarriage?

5.     How many pregnancies resulting in premature babies?

6.     How many babies are born healthy?

7.     Did patients report any issues in healthy babies having any genetic issues like autistic tendencies or other retardation?

Regarding the point number 7, I would like to bring to notice an important research article published by Dr. Lorraine Kelley-Quon of Mattel Children's Hospital UCLA, University of California, Los Angeles. Their reports do confirm some of the points mentioned above.

Their research confirms that the incidence of genetic defects of the heart, eye and urinary system are more in IVF deliveries than normal delivery. 

The long journey to motherhood

I thought of creating this blog for one and the only one reason. i.e. to share my long and painful journey ( still continuing ) towards motherhood. We were a busy couple, DINK type (Double Income No Kids). We were married for 3 years, when we thought of raising a baby.

Our Initial assumption was that it will take 1 year to achieve pregnancy. But as it turned out, we kept trying for around 1 year, and could not be successful in becoming pregnant. This marked the beginning of a long ordeal of visiting hospitals and tests.

Test 1: Wife is PCOD, treatment starts, still trying, no result

Test 2: Husband to check sperm count , came low, another treatment, improves.

Test 3: Wife still not becoming pregnant, GO FOR HSG to check fallopian tube. So scared & thinking of HSG alternatives.

Test 4: HSG is Painful procedure but went OK, yet no positive results.

Test 5: Fixes appointment for IUI in Manipal hospital, Bangalore (India)

Surprise 1: Pregnancy test is positive . Hurray. Is that all?? No it’s just the beginning.

Surprise 2: Low baby heart rate. Suspecting a miscarriage.

Surprise 3: Red colour bleeding. Again suspecting a miscarriage.

Surprise 4: Pregnancy survives (May be it’s a progesterone effect)

SHOCK 1: Cervix Opens too much. Will I miscarry?

SHOCK 2: Membranes come out. Imminent danger until it goes back in. BED REST NOW until delivery.

SHOCK 3: Still the same condition. Doctor to risk pushing it back and do Cerclage ( cervix stitching )

SHOCK 4: As soon as I moved to 3rd trimester, the sugar levels peaked to 230. It should ideally be 120. So took 2 types of Insulin, NOVA-MIX and NOVA-RAPID. Visits to Diabetologist/Endocrinologist start. We started consulting Dr. Arpan Bhattacharya.

I WENT ON BED REST & Insulin just hoping for the best results. Luck, luck, luck please.

=== Update as on 13th Nov 2011 (Hoping to cross AT LEAST 34 weeks) ===

I have crossed 32 weeks today.

Thx all for your wishes and encouraging comments. It’s been rock & roll since 20 weeks.

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=== Update as on 19th Nov 2011 (THE DELIVERY DAY - UNEXPECTED DATE)

Gave birth to a beautiful baby girl @ 33 weeks.

No more insulin, progesterone or bed rest 4 me.

She is in NICU. Read My NICU Experience.

Thx u all. I love u.

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=== Update as on 10th Dec 2011 (NICU and JAUNDICE STORY)

My baby girl is doing fine. She is around 20 days and weighs just 1.7 kgs. She was discharged from Manipal NICU after 5 days and had to spend another 5 days in the ward due to jaundice. Dr Arvind Shenoy and Dr Karthik Nagesh both attended to her and I was satisfied with their approach and consultations. 

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Things that highly bothered us were:

--> When you are admitted for delivery, you will expect the best of the doctors and especially your gynaecologist to be present, especially when it's going to be little off-course, as the baby is going to be premature and myself having stitches. My consultant doctor or for that matter, no gynaecologist was present in the labour room. It was just the duty doctors (students who have to compulsorily give the duty) and the nursing staff.

--> The NICU team was waiting like hungry wolves, for their billing meters to start. Believe me, we were briefed by NICU team about the charges for ventilator and other devices, when I was not even sure , whether delivery will take place in next 24 hrs. or not.

But it doesn't matter, our delivery was fastened and the baby delivery happened in just no time, without any gynaec being present. So this was bad Experience, more on this and the charges in coming weekend.

--> One last thing, I looked at the list of patients’ details and their consultants, pasted outside the ward.

The highest Dr Shobha Venkat (there were 6 admissions, including me)

Dr Praveena Shenoi (there were 3, and I got very positive feedback about her from fellow patients. I have seen here twice attending to mid night delivery. ) She is my next doc 4 sure. See her in cloud 9 as she has shifted there.

Dr Manjula Shivshankar and Dr Shaila Bhattacharya (2 each)

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== Update as on 7^th April 2012 (PREMATURE BABY SLOW GROWTH)

Current weight: Just above 4 kgs

Age: 4 months

Delayed milestone 1: - Eye contact, first at 4 months

Delayed milestone 2: - Weight gain, just above 4 kgs at 4 months

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== Update 14^th April 2013

Current weight: 9.3 kg

Age: 1 year 4 months

Milestones: All MET as per normal baby standards (Having met the weight goal and above average height). Who says premature babies can’t beat the goals?

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My baby is now 4 months of age weighing little over 4 kg. We know she is slow in gaining weight as compared to other kids of her age, but we hope she will match in a year or so.

We are amused by so much of vaccination dosage for the small one. We never thought that so many dosages and some of them costing upwards of 2000 INR upwards. Do I have an option?

The cost of the same vaccination varies drastically from 100 INR to 2000 INR depending on the hospital and the pharmaceutical company. Some vaccines are considered mandatory by 1 set of doctors , while another says opposite.

Another delayed milestone was the eye contact. We never realized that Retinopathy of prematurity (ROP), which we missed was such an important test. We missed it, as we were extremely busy in the related baby stuff. But yeah it is important.

(DIABETES MIGHT BE BACK)

WIFE: HAD GESTATIONAL DIABETES, and now 4 months after delivery, sugar levels still peaking at around 230. So we were very worried now. GTT (Glucose Tolerance Test) is another stuff that was supposed to be done at 6 weeks post delivery, but impossible to have got it done, with such a small baby.

We did a HBA1C and levels were 7.9

Repeated this and with medication went down to 6.6 (still high enough)

== Update 13-7-2012

Repeated HBA1C test

Gestational Diabetes has been confirmed to have turned into Type 2 diabetes.

We were referred Metformin and Trajenta (Linagliptin) by Dr. Mohan of Endocrinologist department Manipal.

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== Update 14-04-2013

Continued Medication and after 4 months repeated HBA1C. The report showed 5.6 and this was an achievement, since the levels sustained even after stopping the medication two months back. So we were told to stop the medication and be on good diet and maintain exercise regime.

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(THE FORMALITIES)

Got her birth certificate from our local municipal office BBMP, but realized later that signatures are missing. Oops have to run again.

Went again for signatures on birth certificate, but BBMP said signatures are not required as, the birth certificate is digitally signed.

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Improve sperm count and motility: 10 things you can do now

1. Increase food and drinks that have more zinc content, such as Oysters, Dried watermelon seeds, Peanuts, Mutton and Crab. Zinc will also help increase your appetite, arrest your hair fall, and is good for your eyes and skin as well.

2. Selenium is known to make certain proteins that constitute sperm. Sea food, eggs and meat products are known to increase selenium levels. For vegetarians, they can try mushroom, Onions, Oats and Barley.

3. Exercise and/or yoga to manage stress. Lose excess fat.

4. No alcohol while trying to conceive, in order to keep hormonal balance.

5. Avoid exposure to radiation, chemicals and heated areas.

6. Avoid hot water, especially on genitals. (Take cold bath, before bed time for a temporary boost in sperm motility. )

7. Do not keep laptop on lap, instead use a desk.

8. Do not wear skin tight underwear.

9. Limit your coffee to 1 cup per day. Use green tea instead. (Herbal and gives similar kick. Yes it takes time to get used to it. )

10. Avoid smoking.

IVF Risks to Mother due to Infertility drugs

Part 1: IVF Risks to Mother due to Infertility drugs

This is the first part of the series (IVF Risks to Mother) , and before I start , I would like to outline the impact and side effects of fertility medicines on women undertaking IVF, IUI, ICSI or Ovulation Induction. These medicines increase the Gonadotropins hormones which are nothing but proteins like FSH, LH, and HCG. Remember these, when the doctor asked us to get these tests done, while your initial checkups with the gynecologist or the andrologist.

While we do not know for sure, how many women experience these side effects, but even a single occurrence may lead your doctor to terminate the cycle. The additional hormones may lead to large size ovaries, which may not be optimal for healthier eggs.

A woman having adverse reaction to such drugs is likely to observe these side effects and symptoms:

1. Persistent pain in lower abdomen

2. Breathlessness

3. Spotting

So is there any solution to control and limit the effect of excessive Gonadotropins hormones produced by the fertility medicines? The answer is Yes and No.

Yes because the doctor can re-adjust the dosage of HCG shots and might give you lighter concentrations of FSH and LH.

No because the doctor cannot properly examine, how much dosage of IVF stimulants is enough for a woman?  A lower than require dosage might result in lesser than required eggs or the eggs so produced may not be very qualitative enough for reproduction.

NICU Experience - The Good , The BAD

Manipal NICU

The overall experience with the NICU unit of Manipal was good.( Of course I am not considering the cost factor , If you have insurer that covers NICU admission , I would recommend yes).

THE GOOD: ( What I Liked )

Very professional. I know they are supposed to be , but  I did not see any violations of hygiene , handling babies , administering baby feeds , helping the mother to handle the wire trapped baby. They knew it well , and were good at it. Saw them handling a 600 gms baby , a baby on ventilator , many babies on photo therapy.
Did not allow any relatives . Did not allow even father ( beyond 1 hr visiting time in morning )
My relatives waited to see the baby face for 5 days !!! Hmm..... I hope they were lenient , but their are other infection prone babies also , so I understand

THE NOT SO GOOD 

Around 30 + beds. Only 2 senior experienced Consultants ( Dr Arvind shenoy and Dr Karthick Nagesh ). No doubt about their abilities . They are good. But man you are handling too many babies.
There will be conference in the morning around 10 am. Parents queue up to meet the doc outside NICU gate. First come first serve. No matter which doctor you opt for ( or allotted ) only one of the consultant will be available to update you and answer your queries. This is the only time you get to see them , and rest of the day you can't directly talk , but can reach duty doctors .Any emergency , they will contact the consultant.

THE BAD: ( REALLY BAD )

You need to feed milk to the baby every 2nd hour ( who is admitted in NICU). The NICU is not just next room. It is far . If u r on 10th floor , you will  need to go to NICU on 2nd floor. You need to call the sister , once she comes in , tell her to call the wheel chair guy. This guy will be the most busiest person in the world.

Follow up , follow up , and 15 mins if u r lucky. Now go to the NICU. Feed ur baby , Again wait for the wheel chair guy.
Sometimes I was escorted by husband back to the WARD , and this became our preffered option for the next few days.

You just delievered , mine was normal , but C-Section imagine waiting for wheel chair?? ( W8ing , w8ing only to reach late and find that , they already fed the baby with formula milk , since I came late. But I called them , yet they fed the baby... Ummmm . Should I be angry or not ? )
I have seen many couples in that situation ,and have shouted innumerable no of times on deaf ears.


Now the night schedule . They wont allow you in NICU after 11 pm , so need to express milk using a breast pump and send it to NICU every 2nd hour. Too difficult to express the milk , real struggle for first time mother. You must have a private ward , or request for the window side in the shared ward , so you have the privacy of expressing milk. Else the husband needs to stand guard , and in that tension , it becomes so hard to express. UFFFF....

So the schedule is like this: ( Husband's duty )
1st feed : 11 pm Night ( Ok , 11 pm is no big deal )
2nd : 1 am morning ( Workable , But difficult to express milk at that hour of night. Isnt it? )
3rd : 3 am ( Imagine the condition of wife )
4th : 5 am ( Too tired , red swollen eyes )
5th : 7 am ( Ohhh man , thats it , we tell sister to give formula milk only )

( and I am serious ) Probably this was that period of life , which I would really not like to happen again.


What you need to be prepared with:
1. Steel containers : ( Around 50 ml capacity ) . Keep around 6-8 with you. Because every 2 hr you need to give it to NICU nurse, and she returns you back in morning.

Available in hospital , but costly.
2. Collect daily bill statements from hospital. Available for free on request. And if the diapers/baby oil/powder are too costly above MRP , get it urself. Ur insurer wont pay for these, and u r the best judge , as to which diaper ur baby fits best in.
3. Another close relative staying in the hospital. Since after the night shift , you need some hrs rest , else sure shot will fall sick.
4. Diapers and Baby Wipes : and lots of it. Lots
5. Home made food. ( If possible ) : Hospital food is good, but with all the green chillies coming out of their sambhar , my grandma prefers having home made food.
6. Don't buy 2 many new born clothes. The baby will outgrow them in a few weeks. So dont buy too many in excitement. I bought 5k worth of it , and now none fits.
7. Discharge time: It can throw some surprises. So keep in touch with the corporate people on the ground floor and your hospital co-ordinator , and ensure bills and reports are synced up.

Female Fertility Rates on decline in Karnataka

Update: 1 more recent article on TimesofIndia.com

Fertility rate is on the decline in Karnataka. In a report published by Institute for social and economic change (ISEC), Bangalore, the total fertility rate (TFR) of the women in Karnataka has dropped to 2 children per woman.

Is Fertility rate of 2 children less?

Yes, since this is just an average taken across both rural and urban areas. And since the population growth rate in rural areas is very high, it simply implicates that the situation in urban areas is more worrisome than is stated by the figures. Secondly it does not take the mortality rates into account, so the real average can be even lesser.

But Fertility rate of 2 children sounds good!! Why is it a problem?

A fertility rate of 2 will mean that a woman will see 2 children in her life span. That means the woman and her spouse (2 people) have given birth to another 2 .If this is considered average, then it will mean the population will just be able to replicate itself effectively meaning 0% growth rate in population. So a rate less than 2 will mean negative population growth.

Negative growth rate... really?

Excerpts From wikipedia

Sub-replacement fertility is a total fertility rate (TFR) that (if sustained) leads to each new generation being less populous than the previous one in a given area. In developed countries sub-replacement fertility is any rate below approximately 2.1 children born per woman.

Ok, then why is the population of a city like Bangalore increased by 48 % over the last decade?

The population growth in Bangalore is attributed more to migration of people from other cities all across India and rural places in Karnataka. The figure of 48 % is total population growth, and not the growth in female fertility.

How are the individual female fertility rates in Bangalore?

As of now, I haven't come across any statistics related to fertility rates or IVF/IUI treatments in Bangalore. There are around 30 fertility clinics in Bangalore. Big players such as Nova are about to enter Bangalore landscape. The Indian IVF market is more than 1.5 billion dollars growing at more than 20 % yearly.

Second Trimester Miscarriages due to Cervical Incompetence

Closing the cervix by applying stitches ( Cerclage )

Cervical Incompetence is diagnosed when a woman is found to have a cervix that is opening, or she delivers the baby extremely prematurely without any associated contractions.
It is usually a second trimester disorder where the cervix which needs to remain close throughout the pregnancy, starts dilating and/or thinning.

Who is at the risk for this problem?
Primarily a woman who has had procedures on her cervix done before such as:
1) Cervix Conization (Biopsy of Cervix)
2) Leep Procedures (Removal of abnormal tissues from Cervix)
3) D & C procedure

This may disrupt the tissue of the cervix, so that it is unable to stay closed. Some women have Cervical Incompetence without any risk factors at all, especially women that have had this happened in their prior pregnancies or those who have history of pre term labor and weak cervix.
When a woman is at risk for cervical Incompetence, her doctor will take specific measures to try to find out, if this is the problem in the current pregnancy as well. Some of the ways this can be examined is by doing a transvaginal ultrasound or by manually checking the cervix, whether it is getting shortened or effaced.
Often, when you do an ultrasound in the second trimester, they are going to check the length of the cervix just to make sure that it’s still competent and closed.

Symptoms of Cervical Incompetence
These include subtle symptoms such as:
1) Feeling a lot of pressure
2) Feeling the need to push, as if the baby is coming out
Early in pregnancy, when the cervix first starts to open, there may not be any symptoms at all except for some changes such as spotting or discharge.

Treatment of Cervical Incompetence
Well, if the doctor(s) can catch this problem in early pregnancy before the cervix opens too much, then they may decide to do a procedure called “Cerclage”.
A Cerclage is where a doctor places a stitch in the cervix in order to hold it closed and strengthen it until the end of pregnancy. T when a doctor will remove the stitch so that a woman can deliver a baby.
Whether or not a Cerclage is appropriate for you will really depend on a lot of specific details about your case and needs to be discussed with your doctor.

Diagnosis
In second trimester ultrasound scans , the sonographer must check for the length of cervix. If the cervix is found to be opened , the patient should be immediately sent for a more detailed physical examination of the cervix by the OB/GYN to determine any possibility of amniotic fluid getting pooled in the cervix area. Depending on your situation the doctor will prescribe for stitching the cervix. However if it is found that the membranes have come out of the cervix and reached till internal OS or external OS , the doctor might might advice strict bed rest and wait until you cross over to 28 weeks , or the doctor might decide to stitch only the outer part of the cervix.

Summary
Mere the opening of the cervix does not indicate that a miscarriage is imminent , neither it implies that Cerclage is the only solution. It also depends a lot on the progress of one's pregnancy , whether there is a balooning of the membranes . Cerclage can never be done if the cervix is too short ( < 0.5 cms ) or if the membranes have reached till the external OS of the cervix.

Dr Ranga

Test for DNA fragmentation Index is non mandatory

According to a recent study by Professor Sheena Lewis of Queen's University, it was established that SPERM DAMAGE was responsible for more than 80 % of the idiopathic or unexplained fertility cases.

So how is this ‘Unexplained fertility’ diagnosed. ?

Yes, it is done by this very test called as DFI. (DNA fragmentation Index)

So why am I saying that it is not mandatory? Well I am not saying that if your doctor has suggested the test, then you shouldn't go for it. I just want to let you know, that the DFI test is done in those cases, where none of the previous sperm examination could determine the cause of male infertility.

10 things you can do now to improve sperm counts.

So this test is not the one that you repeat every month or couple of months, like your regular sperm counts and sperm motility tests.

Doctors having tie ups with Diagnostic centers is nothing new. They get attractive commissions and hospitals that have in house diagnostic facilities even have the pre-defined targets and fixed incentives for consultants.

Think of the fertility related diagnostic tests, which are not even covered by the insurance companies in most countries, and this really punch a big hole in the pocket.

I was once referred for this test called DFI (DNA Fragmentation Index). When i got the report it mentioned just one % figure. For me it was 56 % and according to my doctor it was very hopeless, as the report suggested that the baseline should be under 20 %, while mine almost thrice. But when I kept reading the report, there was a clause mentioned just below the last page.

DFI is a relatively new test, the effectiveness is yet to be realized on a large scale. Another line in the report meant that it cannot be ascertained that patients with less DFI will establish more successful pregnancies than those patients with the higher DFI value.

This is followed by another statement that DFI is just a statistical analysis, and it usually means that patients with higher DFI value may take more time to establish a successful pregnancy.

The final nail was when the doctor told me that, it cannot be treated, even with an operation. I thought of not wasting any more money on this test, and tried on my own after taking certain medicines such as Paternia and Zinc tablets and yes that was sufficient to carry my DNA to where it should be now. :) [Yes I am blessed with a beautiful baby now  J. ]

(This is only my personal observation and not a recommendation. Please follow the advice of a senior fertility specialist. Our advice is just to take second opinion, in case, if you have been referred for continuous fertility tests. )

Sure Fertility Review ,pricing and doctor profiles

Their website mentions the below doctors. Dr Reeta B has good reviews.

Dr. Reeta Biliangady

Dr. Uma Maheshwari

Dr. Jyoti Menon ( Our preference )

Dr. Sumana Gurunath

Dr. Indu S.T. Gopal

I have personally consulted Dr Jyothi Menon, in Manipal Hospital and I can actually vouch for her. My experience with her was very pleasing. She did not rush me into IUI or IVF but kept that as a last choice only. She gave sufficient time to her patients unlike other top ones, who were too busy to give you even 2 minutes. No harm in taking a second opinion from her.

About Sure fertility IVF cost. They have mentioned it as 60 k for IVF and 70 k for ICSI, which I think is quite reasonable as per Bangalore standards, and that too for a specialist infertility clinic, I believe it’s worth paying for.

Just checked for Sure fertility reviews, I didn't find much concerns, so here are my 2 cents on Sure fertility.

Pros:

1. Doctor's credentials are good. Just Google around.

2. Treatment costs are reasonable as compared with other fertility clinics.

Cons: 1. One of the reviewers mentioned that Sure fertility changed the consulting doctor. Unfortunate but unavoidable. Consider contacting that doctor in another hospital.

2. If it matters to you: Ultrasound is in -basement floor. No lifts to -1. If you are pregnant in 8th/9th month, may be little uncomfortable.    (As per one of the comments:  Ultrasound is now in ground floor.)

Cervical Incompetence : Getting pregnant is only the start of journey

After I got pregnant , I started dreaming for my baby. Since after all my ordeals & efforts to become pregnant, nothing can be so satisfying to see 2 Pink lines on the pregnancy test. Oh my GOD ! , It was so premature on my part to think like that.

I did conceive with the help of 3-4 Ovulation Induction procedures , Underwent painful HSG test to check whether my fallopian tubes were fine . I was about to go in for IUI , when the pregnancy test confirmed that I was expecting.

So what next after pregnancy confirmation: ( A dozen of surprises awaits you !!!!)

1. The confusion among the doctors about the best heart rate :

My baby was a slow starter . His heart rate was 108 bpm in 6th week. Some doctors said it's very low. While others seems to be of opinion that it's too early to be reliable. Some said it also depends on the ultrasound sensitivity , while some said that at a minimum it should be 120 bpm. I kept looking online digging for more information , saw case studies & survival ratios of babies with low heart rates in first trimesters and ended up getting more confused , than I was initially. I was just taking progesterone vaginally and left it on the GOD !!

2. The confusion regarding the discharges ( Theory behind the red , white or brown discharges )

I was having slight brown discharge as well, sometimes white discharges ,  so again some doctors said , brown might be a early sign of miscarriage ,while some others said it's normal until I have red colored discharges.
Doctor A kept giving progestrones.
Doctor B was of the opinion , that since I have low heart rate and brown discharge , I will eventually miscarry.
Doctor C was a family doctor and told that , there is nothing to worry unless the discharge is red in color. He adviced taking progestrone shots bi-weekly.

Also few of the fellows told me that , brown discharge is old blood and there is nothing much to worry , unless it is smelly and frequent.

3. The day I got red colored discharge ( The mysterious red colored discharge, that disappeared )

All hell went loosed for me. I was crying like anything . Husband rushed from office , and immediately shifted me to hospital. They did a physical examination of cervix, Everything was fine , no blood anywhere. Then followed it up with an ultrasound . Everything normal again.  The baby's heartbeat clocked 182 bpm. Awsome , and I came back home , as if I won another battle.


4. The first trimester risk : ( Complete bed rest )

This is becoming a trend these days , Complete bed rest for first trimester. Don't know how working ladies will manage this?

5. The Second trimester shock. ( The open cervix and hospitalization )

Just regular ultrsound in 20 weeks i.e. anamoly, The USG doctor gave a rude shock , that my cervix is open , and the membranes are almost on the verge of coming out , so I must be admitted immediately. With no choice , I got admitted in the same hospital itself ,that carried out USG , knowing very well , that it is a money sucking hospital.
They put me on a tilted bed , with my head on the lower side and my legs on the incline.

6. The wait for membranes to go inside cervix ( Waiting & waiting for cerclage )

So many new medical terms , OMG , never thought I will come across these. They waited 48 hrs for the membranes to go inside, but they did not go inside on its own .So they updated me that I will have to carry on in this position for the rest of my pregnancy.

7. The tough Choice ( Do a cerclage having 50 % success rate in my case or carry on bed rest  )

I decided to go for cerclage @ 50 % risk . Since bed rest alone cant guarantee even 25 % , although  I could have carried the bed rest for next 4 months, was even ready for carrying out all daily activities on bed , if that guranteed me my baby.

8. The cerclage done ( waiting for the risk period of 1 month )

They pushed the membranes inside the cervix. Stitched the cervix on a length of 1.5 cms . They told me that , they would have comfortably done that , if I had 2.5 cms available. But nevertheless , they did not want to push the membranes so hard , as they might rupture.
Now I am still on bed rest. I am allowed to go to bathroom , but other than that I have to be on the bed. If I pass one month , then I am at good chance of carrying till term


9. The chance for pre-term baby

So negative I have become that , these days i Just search the internet for pre-term babies , as I just want to carry on for at least 8 more weeks ,which according to the doc , is a viable time line for them to save the baby.

OMG !!! Never though so much happens after you become pregnant.
None of my moms ,grandmas faced these . Some of them never went for an ultrasound. !!!!!!!!!!

Most common IUI side effects

Common IUI Side effects:

• Pain/Side-effects of IUI due to improper procedure
• Side-effects of IUI due to HCG shots
• Abdominal cramps
• Infections
• Bleeding after IUI

IUI side effects are closely related to the fertility drugs administered by the doctor. Also some of the discomfort and pain might also be caused due to improper IUI procedure.

In IUI, the male sperms (spermatozoa) are placed in the woman's cervix or uterus. This is accomplished by a catheter, the same instrument that is also used for inserting dye while performing HSG test. See the catheter here: HSG Catheter and pain.

1) Pain/Side-effects of IUI due to improper procedure.

NATURAL CONCEPTION è Prostaglandin is filtered before reaching Uterus

IUI CONCEPTION è Prostaglandin might directly reach Uterus

What prostaglandin can do to you?

àSpotting or some patches of brown and red blood.

àSevere abdominal cramping on either side of abdomen

àInfection

Lifetime of symptoms è First Trimester, if the pregnancy sustains.

If semen is not washed properly it may contain residual compounds like prostaglandin. This is secreted form prostate glands, and contains some quantities of proteolytic enzymes and zinc. In a natural conception, such enzymes are filtered out before they reach the uterus.

In IUI, these residues can cause serious abdominal cramps, spotting or infection. If you are found to be pregnant after IUI, these enzymes will come out in form of mild spotting, within the first trimester, before the placenta develops.

If IUI does not result in pregnancy, the residual will come out naturally through normal menstrual cycle.

Prevention and Treatment:

 è Choose reputed and proven centers for IUI that have good track record.

 è Spotting mild or otherwise, seek medical advice.

2) Side-effects of IUI due to HCG shots

The HCG injections taken to stimulate egg production inside ovaries can cause OHSS (Ovarian hyper stimulation syndrome). This is nothing but swelling in ovaries due to more HCG given than required. (You might have already attained pregnancy while you were on HCG, so it can’t be always measured or predicted the exact dosage of HCG required for attaining a pregnancy, so some women develop OHSS.)

The symptoms of OHSS may be

à Weight gain (more than 3-4 pounds a day)

à Vomiting

àAbdominal cramps and swelling

 àDifficulty in breathing.

What OHSS can do to you?

It will depend on the severity of the symptoms, and in most cases if diagnosed and treated within time, can be kept under control for full duration of pregnancy.

If not diagnosed, the symptoms might aggravate to result in:

èFluid collection in abdomen

èRenal problems resulting in renal failure

èBlood clotting

3) Abdominal cramps

Is this a side effect that happens only when the conception happened due to IUI?

The answer is No.

Even in normal conception, 80 % of women feel cramps during early stages of their pregnancy. Cramping is a natural body reaction to:

àExpanding uterus stretching abdominal vessels making way for the baby to fit in

àImplantation of Egg in uterus

When to take cramping seriously:

àIf the cramping is continuous and persists for more than 24 hours.

àIf the cramping is accompanied by bleeding or spotting.

Whether IUI aggravates cramping?

No 

Most of the women will experience some cramping during and after the procedure. Do not take over the counter medicines to soothe you from the pain. Ask your doctor, as they are more likely to prescribe such pain killers that do not interfere with impending pregnancy.

4) Infections

Symptoms:

àPain or irritation during urination

àSmelly vaginal discharge

These may be due to not maintaining sterile precautions, poorly administered procedure or pre existing infections. The symptoms are generally burning sensation or pain during urinary discharge, or smelly vaginal discharge. Your doctor will generally recommend antibiotics and anti-bacterial solutions for the treatment of the same.

5) Bleeding after IUI

Mild red discharge once-twice a day is considered normal. It should stop by itself in 2-3 days but if you can’t live without your pads on then you must visit the doctor immediately. The doctor will usually look for any sign of injury and ask you to avoid the intercourse.