Couples who come to me after months of trying to conceive usually arrive with the same set of anxieties. They have Googled IVF success rates until 2 AM. They have been told by someone — a relative, another doctor, a forum — that they should have started earlier, or that IVF is their only option, or that it almost certainly will not work after a certain age.
Most of what they have read is either incomplete or written to keep them on a page. I would rather spend the first consultation giving them an honest picture.
I have 17 years of experience in fertility and reproductive medicine. I did my Fellowship in Reproductive Medicine at Milann Hospital in Bangalore — one of the country’s most respected IVF centres. Before starting Aadya, I was Centre Head at Seeds of Innocence in Delhi and worked as a Fertility Specialist at SCI IVF Centre and Zeeva Fertility in Noida. I have a particular clinical interest in recurrent implantation failure and poor ovarian reserve — the harder cases that often come to me after other clinics have not found an answer.
Here is what I actually say at a first consultation.
Not everyone who comes in needs IVF
This is the first thing I say, and I mean it. IVF is the right treatment for some couples. It is not the default next step after six months of trying. Before recommending IVF, any responsible fertility specialist should have ruled out the treatable causes — and there are several.
Hormonal imbalances like thyroid dysfunction, elevated prolactin, or low AMH are common and often correctable. PCOS causes irregular ovulation but responds well to targeted treatment. Male factor infertility is involved in roughly half of all fertility cases and is missed far too often because the semen analysis is done late, or not at all, in the early workup. Blocked fallopian tubes can be identified with an HSG test. Uterine issues show up on ultrasound or hysteroscopy.
IUI — intrauterine insemination — is significantly less invasive and far less expensive than IVF. For couples with open tubes, a reasonable sperm count, and irregular ovulation, it gives a real chance of conception and should be tried in appropriate cases before IVF is recommended. I have seen couples who came in convinced they needed IVF conceive on a second round of IUI. The workup matters.
What an IVF cycle actually involves — without the jargon
Once we have established that IVF is the right path, here is the process as I explain it:
You start with ovarian stimulation — hormone injections over 10 to 14 days to encourage multiple eggs to develop. During this time you come in for monitoring scans and blood tests. The injections cause some bloating and discomfort but are manageable for most patients.
Egg retrieval is a brief procedure done under sedation. You are not awake for it. It takes about 20 minutes and you go home the same day. The eggs go to the embryology lab, where they are fertilised with your partner’s sperm — or donor sperm if that is the plan. In cases of poor sperm quality, we use ICSI, which involves injecting a single sperm directly into each egg.
The embryos are cultured for 3 to 5 days. The best quality embryo is selected — ideally at blastocyst stage, which improves implantation rates — and transferred to the uterus in a simple, painless procedure similar to a smear test. Two weeks later, a blood test confirms whether implantation has occurred.
That is the standard cycle. What varies is the protocol — the stimulation approach, the trigger medication, the endometrial preparation, the support after transfer. These decisions are based on your specific test results and history, and they matter more than most patients realise. The same woman going through two cycles with different protocols can have very different outcomes.
What to ask any clinic before you begin
I would encourage every couple to ask these questions at their first appointment — at any clinic, including mine:
- Do you have an in-house embryology lab, or is embryo culture outsourced?
- Who performs the egg retrieval — will I see the same doctor throughout my cycle?
- What does the quoted cost include? Are medications, anaesthesia, and follow- up scans separate?
- If the first cycle does not work, what review process happens before the second?
- Do you have in-house facilities for monitoring scans, or will I need to go elsewhere during stimulation?
On that last point — at Aadya we recently added an in-clinic ultrasound facility, which means monitoring scans during an IVF cycle can be done here without sending patients to a separate centre. During stimulation, timing is everything. Having to coordinate an urgent scan elsewhere introduces delays that affect outcomes.
About recurrent implantation failure — the cases that need a different approach
A specific area of my practice is couples who have done one or more IVF cycles with good- quality embryos that have not implanted. This is one of the more frustrating situations in fertility medicine — for the couple and for the treating doctor.
Recurrent implantation failure is not bad luck. It usually has a cause, and finding it requires a different investigation pathway than a standard fertility workup. That may include uterine assessment via hysteroscopy, immunological testing, thrombophilia screening, sperm DNA fragmentation analysis, and in some cases an ERA test — endometrial receptivity analysis, which identifies the precise window when the uterus is most receptive to embryo transfer. This is not standard practice everywhere. It should be considered before proceeding with another cycle using the same protocol.
Common questions
At what age does IVF success rate decline significantly? Success rates begin declining gradually after 35 and more steeply after 38. This is about egg quality, not IVF specifically. If you are in your mid-30s and have been trying without success for 6 months, early assessment is advisable.
Can PCOS affect IVF outcomes? PCOS affects how the ovaries respond to stimulation — women with PCOS can over-respond, raising the risk of hyperstimulation. With a PCOS- specific protocol and careful monitoring, outcomes are generally good. The condition itself does not reduce success rates when well managed.
Is IVF painful? The stimulation injections are mildly uncomfortable. The retrieval is done under sedation. The transfer is painless. Most patients describe the emotional toll as harder than the physical one.
We do IVF, hysteroscopy, laparoscopy, egg freezing, donor IVF, and IUI at Aadya. I practice Monday to Saturday from 4 PM to 6:30 PM and Sunday from 10 AM to 12 PM. Bring all relevant reports to the first appointment semen analysis, thyroid, AMH, any previous treatment records, so we can begin properly.
