Infertility is defined as the inability of a couple to conceive after 12 months of regular unprotected intercourse. It is a condition with important physical and psychological implications. The causes could be due to factors in the female partner or the male partner or in both the partners. In almost 25% of cases, no cause can be identified and it is called as 'unexplained infertility'.

First putting forth the mechanism of conception very simplistically. The ovaries release the egg. One egg is released in each menstrual cycle. The egg is picked up by the fallopian tube and the sperm (which travels its way up the vagina) and egg meet and fertilize in the fallopian tube. The embryo (tiny baby) then goes into the uterine cavity and gets implanted there. It starts getting its blood supply and grows inside the uterus.

Knowing the process now, the broad reasons why some couples have difficulty conceiving can be worked out. 

  • Causes in the female can be if the egg is not getting formed properly (most commonly due to conditions of hormonal imbalance such as Polycystic Ovarian syndrome).
  • Another factor can be the tubes. Infections or surgery on the tubes can damage tubal structure and function. Tubes can get blocked and hence will not be able to pick up the egg.
  • Any problem with the uterine lining (infection, previous surgery, bands of adhesions) will prevent the process of implantation.
  • Talking about the male partner, any abnormality in the semen parameters (sperm count/ movement/structure) can be a contributory factor.

If you have been trying to conceive with regular unprotected intercourse in the fertile period of your cycle for at least 12 months, without any positive result, you must see your Gynecologist. If the age of female partner is more than 35 years, then meet the doctor earlier (after 6 months of trying). Talking about the treatment part, you must see the doctor as a couple. It’s imperative that both the partners are evaluated together for infertility treatment. You will be subjected to certain tests to identify any possible causes. These tests mostly include a semen analysis for the male. For the female partner test to check if the tubes are open is done. This is mostly done by taking an X-Ray and studying the flow of dye through the tubes (HSG). Having regular menstrual cycles is indirect evidence that the ovaries are functioning properly and forming eggs. But the surest way to check ovulation is by ultrasound. It is started usually from cycle day 9 and done every other day until the follicle reaches the size of 18-20 mm and releases the egg. 

Treatment

The treatment plan depends upon the underlying cause. If the egg is not getting formed properly, you will be given medicines (by mouth/injection) that help in egg formation. This is known as ovulation induction. If the tubes are showing some blockage, treatment depends upon the level and severity of the block. Some blocks can be corrected surgically and when this is not possible you will mostly be referred for an IVF (In vitro fertilization). Mild abnormalities in the semen can be corrected by lifestyle modifications such as avoidance of all smoking, alcohol, not staying in high-temperature areas and washing the private parts regularly with water. If there is a problem in having intercourse this can be bypassed by putting the semen directly inside the uterus. This is called the intrauterine insemination or IUI. 

The problem of infertility is becoming rampant by the day and our lifestyle has a huge part to play in this. Eat healthy, do a daily exercise of 30 min, achieve an optimum body weight, sleep at least 6 hours a day, avoid all addictions (smoke/alcohol/ tobacco/ coffee/ tea in excess) and above all beat the stress. To know more, meet your Gynaecologist!