Across every consultation I conduct at Metro IVF — with couples at every stage of the fertility journey, from first-time patients to those who have been through multiple failed cycles — certain questions recur with remarkable consistency. They are the questions that couples carry into the consultation room having already spent hours searching online, having already received partial answers that raised more questions than they resolved, having already formed ideas about what is happening to them that are sometimes accurate and sometimes not.

These are the questions that deserve complete, honest, specific answers. Not the hedged, non-committal answers of a doctor who is managing liability rather than communicating information. Not the oversimplified answers of a health website that has been written for engagement rather than accuracy. The answers that come from a specialist who has spent a career in reproductive medicine, who has seen these questions in every variation, and who understands not just what the answer is but why the question is being asked and what the person asking it most needs to understand.

These are the ten questions I am asked most often. Here are my answers.

Question 1: How long should we try before seeing a fertility specialist?

The general guideline is twelve months for couples where the woman is under 35, and six months for couples where the woman is 35 or older. These timelines exist because natural conception can take time even in fully fertile couples — the monthly probability of conception for a healthy, fertile couple in their late twenties is approximately 20 to 25 percent — and most couples who will conceive naturally do so within twelve months.

However, these guidelines are starting points, not rules. There are specific circumstances in which I would recommend seeking specialist evaluation immediately — not after twelve months, not after six months, but now.

If the woman has irregular or absent periods, or a known history of PCOS, endometriosis, or previous pelvic surgery or infection, seek evaluation now. If the man has a known history of testicular surgery, significant illness affecting the reproductive system, or a prior semen analysis that showed abnormalities, seek evaluation now. If the woman is 38 or older, time is a biological variable that cannot be recovered — seek evaluation now.

The guideline is for couples with no known fertility risk factors and a woman under 35. If that description does not fit your situation, the guideline does not apply to your situation.

Question 2: Does a normal semen analysis mean my husband's fertility is fine?

No. This is one of the most important clinical misconceptions I encounter — and its consequences for couples who accept this reassurance are significant.

A normal semen analysis means that the count, motility, and morphology of the sperm — the three parameters measured by standard analysis — fall within the reference ranges established for those three measurements. It does not mean that every aspect of the male partner's fertility has been assessed.

The critical unassessed dimension is sperm DNA fragmentation — the integrity of the genetic material within the sperm. Sperm DNA fragmentation is not measured by standard semen analysis. A man can have perfectly normal count, motility, and morphology with severely elevated DNA fragmentation — and that fragmentation can be compromising embryo development and implantation rates in ways that are entirely invisible to the standard analysis.

If a couple is experiencing unexplained infertility, recurrent implantation failure, or repeated early pregnancy loss, and the male partner's semen analysis has been described as normal, the investigation is not complete. Sperm DNA fragmentation testing must be specifically requested and specifically performed. I perform it routinely at Metro IVF for every male partner regardless of what the standard analysis shows.

Question 3: What is AMH and what does my result mean?

AMH — Anti-Müllerian Hormone — is a hormone produced by the small follicles in the ovary. Its level in the blood reflects the size of the remaining follicle pool — the ovarian reserve. AMH is the most reliable single marker of ovarian reserve currently available.

A high AMH indicates a large follicle pool — characteristic of young women and, importantly, of women with PCOS in whom large numbers of small antral follicles are present. A low AMH indicates a diminished follicle pool — characteristic of older women or women with conditions that have impaired ovarian function.

What AMH tells you is how many eggs are available — not how good those eggs are. This is an important distinction. A woman of 38 with an AMH of 2.0 ng/mL may have an adequate number of follicles for IVF stimulation, but the age-related proportion of chromosomally abnormal eggs will be independent of her AMH. Conversely, a woman of 28 with a low AMH may have fewer eggs available per cycle, but those eggs are more likely to be chromosomally normal than those of an older woman.

AMH guides the stimulation protocol — a low AMH requires a more conservative approach to avoid overshooting the available follicle pool, while a very high AMH requires careful management to prevent ovarian hyperstimulation syndrome. It is the single most important number in planning an IVF cycle. Every woman beginning fertility investigation should have it measured.

Question 4: Is IVF painful?

The honest answer is that different parts of the IVF process are uncomfortable in different ways, and the experience varies significantly between individuals — but for the majority of patients, "painful" is not the word they would choose to describe it.

The daily subcutaneous injections during the stimulation phase — administered under the skin of the abdomen — cause mild stinging at the injection site. Most patients manage these without significant difficulty after the first few days. The abdomen may become tender as the follicles develop and the ovaries enlarge.

The egg retrieval procedure is performed under sedation — meaning the patient is comfortable and unaware during the procedure itself. After recovery from sedation, some patients experience cramping or pelvic discomfort for a few hours, similar to period pain. Most are comfortable and mobile by the same evening.

The embryo transfer is typically painless. It is performed without anesthesia — a thin catheter is passed through the cervix, which may cause mild discomfort comparable to a cervical smear for some patients and is entirely unfelt by others.

The two-week wait that follows is emotionally demanding — but that is a different kind of difficulty from physical pain.

Question 5: What is the real IVF success rate — and what does it mean for me?

The national average live birth rate per IVF cycle in India is approximately 35 to 45 percent for women under 35, declining progressively with advancing age. For women aged 38 to 40, the live birth rate per cycle is approximately 20 to 30 percent. For women over 42, it falls below 10 percent with own eggs — though donor egg IVF in this age group produces rates of 50 to 65 percent.

These figures are population averages. They describe what happens across a large group of diverse patients. They may or may not describe what will happen for you specifically.

Your individual success rate depends on your age, your ovarian reserve, your specific diagnosis, the quality of your partner's sperm, the history of any previous cycles, and — critically — the quality of the investigation and protocol design applied to your case.

When a couple asks me "what are our chances?", I do not give them a population average. I give them an assessment based on their specific clinical picture — what their investigation shows, what their prior cycles revealed, what the treatment plan I am designing addresses. That assessment may be more encouraging or less encouraging than the population figure, depending on their individual circumstances. But it is specific to them — and specific information is more useful than generic statistics.

Question 6: How many IVF cycles should we try before giving up?

This question does not have a fixed numerical answer. The right number depends entirely on the individual clinical picture.

The factor that most often determines when to stop autologous IVF and consider alternatives is not the number of cycles but the clinical information those cycles have produced. If cycle after cycle has failed without adequate investigation — without identifying and addressing specific causes of failure — then the question of how many to try is premature. The priority is to investigate, not to count.

If comprehensive investigation has been performed, specific causes have been identified and addressed, and cycles have been designed around those findings, then the prognosis for each subsequent cycle is different from the prognosis of uninvestigated repeated attempts. In this context, the honest conversation about how many cycles to pursue is one that Dr. Soni has with every couple based on their specific findings — their reserve, their embryo history, their response to treatment, and the realistic probability of success given everything that is known about their case.

What I can say clearly is this: repeating the same cycle without investigation, without a specific explanation for why previous cycles failed, and without a genuinely different approach is not a productive use of additional attempts. The number of cycles matters less than what each cycle reveals and how that revelation changes the next one.

Question 7: Should we test our embryos before transferring them (PGT-A)?

Preimplantation genetic testing for aneuploidies — PGT-A — screens embryos for chromosomal abnormalities before transfer, identifying which embryos carry the correct number of chromosomes and selecting only those for transfer.

PGT-A is most clearly beneficial in specific clinical situations. Women over 37, in whom the proportion of chromosomally abnormal eggs — and therefore embryos — is substantially elevated. Couples with recurrent pregnancy loss — where chromosomal abnormality in the embryo is a common cause of early miscarriage. Couples with repeated implantation failure despite apparently good embryo morphology — where undetected chromosomal abnormality in the embryo may be the cause. Couples producing several blastocysts per cycle who want to identify the best embryo for transfer rather than choosing by morphology alone.

PGT-A is not universally appropriate. It requires embryo biopsy, which adds cost and a small procedural risk. It reduces the number of embryos available for transfer by eliminating the aneuploid ones — which in some couples with limited embryo yield may reduce the available options significantly. And it does not guarantee success with a euploid embryo — because implantation depends on uterine factors as well as embryo factors.

Whether PGT-A is appropriate for your specific situation is a clinical decision that should be made in the context of your age, your embryo history, and the clinical picture your investigation has produced. It is a conversation I have specifically with every couple for whom it is relevant.

Question 8: Can diet and lifestyle really affect IVF success?

Yes — but with appropriate qualification about what "affect" means and how large the effect is likely to be.

Lifestyle factors that have a documented, evidence-based association with fertility outcomes include: body weight — both obesity and significant underweight affect hormonal balance, ovarian function, and IVF response; smoking — which is associated with reduced ovarian reserve, poorer egg quality, and significantly elevated sperm DNA fragmentation; alcohol — which at significant consumption levels affects both egg quality and sperm parameters; and nutritional factors — particularly vitamin D deficiency (extremely common in India and associated with reduced implantation rates), folate status, and coenzyme Q10 (which supports mitochondrial function in eggs and has a documented evidence base for improving egg quality, particularly in older women).

These factors are real. Addressing them — particularly stopping smoking, correcting vitamin D deficiency, and initiating CoQ10 supplementation for women over 35 — is part of the pre-treatment optimization I recommend for every patient.

The qualification is that lifestyle optimization is adjunctive — it improves the clinical environment but does not substitute for accurate diagnosis and appropriate treatment. A woman with blocked fallopian tubes will not achieve pregnancy through dietary improvement. A man with azoospermia requires surgical assessment regardless of his lifestyle. Lifestyle factors contribute to fertility, and addressing them is always worthwhile. But they are the background to the clinical treatment, not the treatment itself.

Question 9: We've been told donor eggs are our only option. Is that definitely true?

Not necessarily. The recommendation to move to donor eggs is the right recommendation in specific circumstances — when the woman's own eggs are no longer capable of producing a viable pregnancy at a probability that justifies continued autologous attempts. This is a real clinical threshold, and for some women — particularly those with severely diminished reserve, consistently aneuploid embryos on PGT-A testing, or an age above which the proportion of viable eggs is very low — donor eggs represent not just an option but the most clinically rational path.

However, I am also asked this question by women who have received the donor egg recommendation without adequate investigation. Without having been assessed at a clinic that offers modified natural cycle IVF — which may produce better egg quality than high-dose stimulation in low-reserve patients. Without having had PGT-A testing to confirm whether their embryos are indeed consistently aneuploid. Without having had the comprehensive evaluation that would confirm whether all other contributing factors — sperm DNA fragmentation, uterine environment, immunological conditions — have been identified and addressed.

Before accepting the donor egg recommendation as final, I would encourage every couple to have a consultation with a specialist who will review the basis for that recommendation — the specific investigation findings that support it — and confirm whether the conclusion is founded on a thorough enough evaluation to be reliable.

If the review confirms it — if the evidence genuinely shows that autologous success is unlikely — then donor egg IVF is an excellent option, with success rates that are substantially better than continued autologous attempts. But the confirmation should come after the investigation, not instead of it.

Question 10: How do I know if Metro IVF is the right clinic for us?

Metro IVF is the right clinic for couples who want the most thorough available investigation of their infertility — not a standard protocol applied to a categorical diagnosis, but a specific, individualized assessment of their exact clinical picture.

It is particularly appropriate for couples who have been through treatment elsewhere that did not work — who carry a history of failed cycles or years of unexplained infertility and who have not received a specific, evidence-based explanation for why their treatment has not succeeded.

It is appropriate for couples who value honest communication — who want a doctor who will tell them specifically what the investigation shows and what it means for their prognosis, including when the honest picture is not the most encouraging one.

And it is appropriate for couples in Chhattisgarh, Jharkhand, Madhya Pradesh, and the surrounding region who want access to subspecialized fertility care — the level of clinical depth that has historically required travel to a distant metropolitan clinic — without the logistical and financial cost of that travel.

The best way to know if Metro IVF is right for you is to come for a consultation. Bring every report you have. Let me read your history and tell you what I see. If what I offer is what your case requires, we will proceed. If it is not — if the most honest assessment of your situation points toward a different path — I will tell you that too.

That honesty is what Metro IVF offers. And for couples who have been through treatment that did not give them that, it is, I believe, where the right journey begins.

Metro IVF Test Tube Baby Center Ambikapur, Chhattisgarh metrofertility.in Led by Dr. Ashish Soni — North India's First Fertility Super Specialist

Your questions deserve specific, honest answers. Book your consultation with Dr. Ashish Soni at Metro IVF today.