Approach to Infertility

The “Parenthood” is a “dream” that almost every couple would want to achieve in their life time…Nature greatly contributes making their legacy…..

But in 10 to 15 out of 100 couple worldwide struggle to conceive and face the agony of the  “ Infertility” which is a global public health issue.

The field of Reproductive Medicine and Fertility Treatments is rapidly evolving and thus  reducing the global burden of infertility.

Systematic analysis the problem, skillful team ( Expert clinicians , Embryologist , Nurses), well equipped technology and empathetic approach with continuous emotional support  to these couples is key to achieve their dreams of “Parenthood”….

  • Planning “parenthood”…do the couple need to go to doctor ?

Yes… “Pre conception counselling “ with the Reproductive Medicine Specialist will help the couple to embark on the pregnancy when they have optimal health parameters thus reducing the need for unnecessary advanced fertility treatments as well as complications in pregnancy.

  • What is Infertility ?

Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse.

It is called ‘Primary Infertility’ when there is no prior pregnancy and ‘Secondary Infertility’ when there is history of prior pregnancy including live birth, miscarriage or ectopic.

  • Are there any situations where couple needs to seek advice of Fertility specialist earlier than one year of trying ?

Some special situations are : Female age more than 35 years, known fertility problems in male or female partner.

  • What are the reasons for Infertility ?
  1. Female Factors (35 %)

PCOD, Endometriosis , Poor ovarian reserve, Tubal factor, Uterine factor

  1. Male Factor (30%)
  2. Combined Factors (15%)

Both male and female factors

  1. Unexplained Infertility (25%)

No reason found after complete tests.

  • Is increasing female age is concern ? Why ?

Yes , as the female age increases fertility potential decreases.  Females are born with limited number of eggs. As age progresses the egg destruction process is faster reducing the egg reserve. Thus “age “ and “AMH” (test of egg reserve) decides the timeline for fertility treatments.

  • What are the tests involved to find the reasons for Infertility ?
  1. Focused history and examination of both the partners simultaneously by Fertility specialist is key to categorize fertility problems.
  2. Tests done on female partner :
  • Routine tests & Infection screening
  • Hormonal Tests : AMH (test of egg reserve), D2-4 FSH & LH, Prolactin, TSH,T4,T3
  • Transvaginal Ultrasound
  • Tubal tests : Saline infusion sonography (SIS), Hysterosalpingography (HSG), Laparoscopy and Hysteroscopy and dye test
  1. Test done on male partner :
  • Routine tests & Infection screening
  • Semen Analysis & Semen Culture
  • Hormonal tests : FSH, LH, Testosterone, TSH, Prolactin
  • Genetic tests : Karyotyping, Y chromosome microdeletion
  • Surgical Sperm Retrieval: PESA, TESA, TESE

What treatments would be offered for Infertility ?

Treatment Options are :

  1. Lifestyle management (maintaining healthy diet & healthy weight, stress management, optimization of health prior to conception)
  2. Ovulation  Induction + Natural try
  3. Ovulation Induction + IUI (Intra Uterine Insemination)
  4. IVF/ICSI (In Vitro Fertilization/ Intracytoplasmic Sperm Injection)

The treatment option is chosen based on reason for infertility, duration of infertility and age of female partner. The treatment decision is always a “shared decision” between clinician and couple considering medical and emotional factors. Counselling and emotional support  is an integral part of the fertility treatments. Strategic stepwise approach , choosing right option right time , will help in achieving outcome in shortest possible period.

  • What are the success rates of different treatments ?

The success rate mainly depends on reason for infertility , age and AMH of female partner, quality of sperm and condition of uterus. If all the factors are favourable the success rates of different treatments are as follows :

Treatment Success Rate



Ovulation Induction +Natural try



Ovulation Induction +IUI  (with Husband sperm or Donor sperm) 15 – 20%
Self Egg IVF / ICSI ( with Husband sperm or donor sperm) 50-60%
Donor Egg IVF/ICSI (with Husband sperm) 60 %


IVF/ICSI with donor embryos (donor egg and donor sperm)


Surrogacy treatments with self eggs (with Husband sperm or donor sperm)


Surrogacy treatments with donor eggs         ( with Husband sperm)



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