Infertility is defined as the failure to become pregnant after one year of unprotected intercourse. There are two types of infertility; Primary infertility, which is infertility without any previous pregnancy; and secondary infertility, when there has been a previous pregnancy.

What are the causes of infertility?
A basic infertility evaluation is carried out to find out the cause of infertility.

Common causes of infertility are:

1. Ovulation problems
2. Tubal causes
3. Sperm causes
4. Unexplained infertility
5. Age-related factors

Some less common causes are:

1. Uterine problems
2. Endometriosis
3. Previous tubal ligation
4. Previous vasectomy
5. Various drugs
6. Cervical factors

When to see your doctor?
Though there is no specific time frame as to when to consult your doctor but you can see your doctor if the pregnancy does not take place even after one year of unprotected intercourse.

You might want to wait a little longer if you are in your twenties but if both of the partners are in mid or late thirties then the advice will be to seek professional help.

Age of the female is an important factor for if she has crossed 35 or is near to it then it is advisable to seek help at the earliest.

Is it correct that the female partner is responsible for infertility?
No, male factors account for up to 40 percent of infertility problems.

How would the doctor go about it?
The first diagnostic step is the evaluation of the infertile couple and to determine which partner is infertile.

Normally the steps of a basic infertility evaluation would include:

1. History:
   Taking a thorough medical history including any other medical conditions you might be having, any history of drug intake, and any other obstetric or gynaecological problems that you may have.
2. Physical examination
   A thorough physical examination
3. Blood tests
   Depending on the individual couple’s situation, various blood tests on either the female or the male may be needed. They can include testing for the levels of various sex hormones.
4. Taking a sample of semen and doing a semen analysis
5. Finding out if the woman is ovulating or not (i.e. producing egg in every menstrual cycle)
6. Hysterosalpingogram
   This test is done in order to assess the anatomy of the cavity of the uterus and the fallopian tubes.
7. Laparoscopy
   May be required after basic tests have been done. The surgeon looks inside the abdomen through an endoscope to look for any deformities of the tubes or for endometriosis.

What if they still can’t find the problem?
There are known cases of ‘unexplained infertility’ i.e. cases in which standard testing has not found a cause for infertility

Treatment for unexplained Infertility
This can include a combination of the following modalities

1. Ovarian stimulation
   -by drugs such as ‘clomiphene citrate’
   -using hormonal injections plus intercourse
2. Assisted reproductive technologies as treatment for unexplained infertility
   In vitro fertilization (IVF)
3. Gamete intra-fallopian transfer (GIFT)
   In GIFT a mixture of sperm and eggs are introduced into the end of the fallopian tube at laproscopy.

What is the success rate of these advanced procedures?
Although pregnancy rates vary from center to center on the specific technique used but generally a 30% success rate can be expected.


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