Infertility is defined as when a couple having regular unprotected intercourse for a period of 12 months is not able to conceive. One in five couples have fertility issues and the incidence is on the rise. Stressful lifestyle and infrequent intercourse are among the main causes of Infertility in the urban population. The other causes of Infertility include male causes like sperm abnormalities (low count, low motility, abnormal morphology, absence of sperm), erectile dysfunction, ejaculatory failure, Varicocele, infections etc. Female causes of Infertility include ovulatory dysfunction (problems with egg release), decreased ovarian reserve, tubal block, thin endometrium, adhesions in the uterine cavity, uterine abnormalities, endometriosis, adenomyosis, polycystic ovaries etc. Sometimes there could be both male and female causes together and at times there could no cause identifiable when it is called unexplained Infertility.
A couple is initially evaluated for the possible causes. A baseline transvaginal scan done on day 2 or 3 gives us a lot of information. A semen analysis done after an abstinence of 2-8days will reveal semen parameters. Further hormonal evaluation of the couple, tubal patency tests, hystero-laparoscopy is done as and when required. We could start with natural cycle monitoring where serial scans are done to look at the follicular growth and rupture (ovulation) and the endometrial thickness and blood flow is evaluated. The next step is ovulation induction(OI) where we stimulate the ovary with tablets or Injections for the follicles to grow and release egg and the same is monitored through serial scans.The same cycles could include Intrauterine insemination(IUI) when there is mild male factor infertility, where the processed husband’s semen which is concentrated with good motile sperms is transferred directly to the uterine cavity. If multiple cycles of OI or IUI fail, then the last resort is In-vitro fertilisation (IVF).