Infertility -“A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility".

  • Primary  infertility: couple have failed to conceive before.
  • Secondary infertility: woman has previously been pregnant regardless of the outcome of the pregnancy and now unable to conceive.

Chances of conception: Over 80% of couples in the general population will conceive within 1 year if: 

  • The woman is aged under 40 years- they do not use contraception and have regular sexual intercourse.
  • Half of those who do not conceive in the first year will do so in the second year.

Factors affecting Fertility:

1) Frequency / Timing of sexual intercourse- Every 2 to 3 days optimises the chance of pregnancy— 

Frequency of intercourse - 1 time per week - Probability of conception is 17 %;  3 times per week - Probability of conception (within 6 months) is 50% 

2) Obesity- Women who have BMI of over 30 should be informed that they are likely to take longer to conceive and will affect treatment success rates. 

3) Lower body weight- Women with BMI less than 19 and irregular menstruation should be counselled to gain weight.

4) Smoking- Strong association between smoking and fertility in both partners affects success rates of pregnancy.

5) Caffeinated beverages-  No evidence on effect of caffeine on fertility.

6) Alcohol- Female patients should be informed that 1 or 2 units of alcohol once or twice per week reduces risk of harming a developing fetus. Intoxication may affect semen quality.

7) Tight underwear- There is an association between elevated scrotal temperature and reduced semen quality.

Causes of Infertility:

In about 40% of cases, disorders are found in both the man and the woman.

  • Male - 25%
  • Female - 55 %
  • Ovul - 25 %                
  • Tubal - 20%
  • Uterine - 10%
  • Unexplained - 20%

Basic Work-up for Infertility:

  • Detailed history and physical examination    
  • Past history                      
  • Treatment history        
  • Menstrual history              
  • Obestric history     
  •  Mental history                  
  • Personal history
  •  Physical examination
    •  Pelvic examination (internal and external)
    • Inflammatory - Rule out PID and Cervical erosion

Screening for Chlamydia trachomatis Infections in Women:

Modern diagnostic tests are highly sensitive for the detection of chlamydia; testing can be performed on vaginal swabs or urine culture. The vast majority of chlamydial infections are asymptomatic. In addition, risk is markedly increased in men and women with Neisseria gonorrhoeae or C. trachomatis infection.

  • Semen analysis
  • USG –Male testes –rule out varicose and other testes structure diseases

 Evidence of ovulation (Day 2-3 gonadotropins,FSH, LH, Day 21 progesterone) 

1. Menstrual history of regular cycles.

2. Serum progesterone in the mid-luteal phase of their cycle (day 21 of a28-day cycle) even if they have regular menstrual cycles.

3. Serum gonadotrophins (follicle-stimulating hormone and luteinising hormone)on Day2-3 especially in irregular periods    

Susceptibility to rubella:

A small number of women in their child bearing years, however, remain susceptible to rubella virus because of missed vaccinations (either intentional or unintentional) or vaccine failure. Young adults are now recognized as a population at risk formeasles and mumps viral infections.—  

Testing for rubella antibodies (IgG)

Antibody levels <10IU/mL are reported as 'rubella susceptible. 

Note -- Mostly in secondary infertility or history of abortion

Ovarian reserve:

More important in >35 years old, suspected ovarian failure and to detect response to ovulation induction.

1. Total antral follicle count.

2. Anti-Müllerian hormone of less than or equal to 5.4 pmol/l for a low response and greater than or equal to 25.0 pmol/l for a high response.

3. Follicle-stimulating hormone greater than 8.9 IU/l for a low response and less than 4 IU/l for a high response.

Homoeopathic Approach and Treatment depends on the cause, and varies from medical treatment 

Inflammatory  disease - Calendula, arnica, Euphonium, sil, Bryonia, hydras, Belladonna, Pulsatilla, guic, thuja ,,Hydrosalpix ---angelica ,,merc sulph ,,apis ,apocynum Sabina 

Disclaimer: This article is written by the Practitioner for informational purposes only. Users must not view the content as medical advice in any way. Users are also required to ’NOT SELF MEDICATE’ and always consult a practicing specialist before taking any medicines or undergoing any treatment. Practo and the Practitioner will not be responsible for any act or omission by the User arising from the User’s interpretation of the content.