Infertility is ‘the inability to conceive after 12 months of uninhibited intercourse.’ This means that a couple is not able to become pregnant after a year of trying to conceive. However, for women aged 35 and older, inability to conceive after 6 months is generally considered infertility.

Yes, around 15%-20% of couples are suffering from this. Infertility results from problems in both the partners. If a couple doesn’t conceive in the first year with regular intercourse, their chance of conceiving gets lower each year. About 6% of married women aged 15to 49 years are unable to get pregnant after one year of trying and of these 14% have difficulty carrying a pregnancy to term.

Infertility in men can be caused by many different reasons and is typically evaluated by semen analysis (the quantity and/or the quality of sperms in semen). Semen analysis may show low sperm production or abnormal sperm function. This may be caused by blockages that prevent the delivery of sperms, Illnesses, injuries, chronic health problems, lifestyle choices, unhealthy habits such as heavy alcohol intake, smoking etc and medical conditions such as diabetes.

There are various reasons that lead to infertility in women. Certain problems which affect ovulation, blocked or damaged fallopian tubes, unhealthy uterine conditions and many other reasons can affect formation & implantation of a developing embryo.

As per the individual reasons each of the multiple problems can be tackled by the infertility specialist successfully.

• Age
• Obesity, high blood pressure & diabetes
• Certain conditions & diseases affecting ovaries, fallopian tubes & uterus.
• Overexposure to certain environmental factors, such as pesticides, radiation and other chemicals such as coating of Polytetrafluroethylene (PTFE), popularly known as Teflon seen in non-stick pans & utensils.
• Excessive use of alcohol & smoking, consumption of drugs like marijuana.

Today advanced medical techniques have solutions and treatments for both men and women who are trying to conceive. Treatments like ovulation induction, in vitro fertilization, ICSI to surrogacy etc. are now available. Doctors recommend specific treatments for infertility on the basis of duration of infertility, age and reasons for infertility, and they also consider the couple’s treatment preferences.

The couple should try for a year and still if they are unsuccessful to conceive they should then consult a fertility specialist to get the treatment at the earliest. Women 35 or older should see their doctors preferably after six months of trying. Certain couples may need to consult the infertility specialist even before 1 year. If a women is younger than 35 but has a family history of early menopause, very irregular menstrual cycles or has had certain cancer treatments, she might consider seeking fertility advice sooner.

Ovulation is the process in which an egg (oocyte) is released from the follicle in the ovary. It happens halfway through a typical 28 days menstrual cycle, usually on day 14 or day 15. After its release, the egg moves towards the fallopian tube and stays there for 12 to 24 hours, where it can get fertilized.

Intrauterine insemination (IUI), is a procedure for treating infertility. Sperms that have been washed and concentrated are placed directly into uterus around the time of ovulation, when in, the ovary releases one or more eggs to get fertilized.

Most of the cases can be treated by Gynecologist. Certainly, in all of the above, the experience of an expert fertility specialist or reproductive endocrinologist definitely improves outcome.

Assisted reproductive technology includes medical & surgical procedures used primarily to address infertility. This includes procedures such as intra uterine insemination (IUI), in vitro fertilization (IVF), intra-cytoplasmic sperm injection (ICSI), cryopreservation of gametes or embryos, and the use of fertility medications in addition to other advanced techniques.

Today we have a success rate of 40-45% per treatment cycle. A success rate of ART varies from individual to individual. Factors that affect the success ratio of ART are;

• Age
• Reason for infertility
• Type of ART
• State of the ART clinic
• If the embryo is fresh or frozen

IVF is one of the most effective infertility treatments. In 2022, Data from the Society for Assisted Reproductive Technology on success rates for IVF stated that for women under35, the percentage of live births is 51%.

For women ages 35-37, the IVF success rate is approximately 38.3% and

At ages 38-42, the percentage is approximately 25.1%

On the other hand, ICSI is very effective in facilitating fertilization. While many may think that injecting the sperm directly into the egg would result in a 100 percent success rate, this isn’t the case. While it is certainly very effective, ICSI treatment achieves successful fertilization in between 50-80 percent of cases as much depends on the successful implantation of the embryo into the womb lining after being transferred.

“Ultimately, the thing that impacts outcomes the most is maternal age, so getting started sooner is the best if IVF/ICSI is needed.”

Some common medicines used to treat infertility in women include:

• Human menopausal gonadotropin or highly purified HMG
• Recombinant Follicle stimulation hormone
• Bromocriptine (Parlodel)
• Clomiphene Citrate (clomid)
• Metformin
• Letrozole

Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition that affects woman of reproductive age. It starts around adolescence but symptoms may fluctuate over the time. It can cause hormonal imbalances, irregular periods, excess androgen levels, multiple small cysts in the ovaries etc.