What Is Infertility?
Infertility is defined as the inability to conceive a child after one year or more of regular, unprotected sexual intercourse. Many couples feel confused about the different fertility treatment options, so it is important to first understand the condition clearly.
Infertility affects both men and women and is recognised as a medical condition, not a personal failure. It is more common than many people realize, affecting a significant proportion of couples worldwide and often creating emotional, social, and physical stress.
There are two main types of infertility:
- Primary infertility: Couples who have never been able to conceive a child despite having regular, unprotected intercourse for at least one year.
- Secondary infertility: Couples who have conceived at least once in the past but are now unable to achieve another pregnancy.
With correct diagnosis and timely treatment, many couples can achieve their dream of parenthood through appropriate fertility care.
What Are the Causes of Infertility?
The causes of infertility can arise from the female partner, the male partner, both partners together, or remain unexplained even after detailed evaluation. Understanding these possible causes helps in planning the right investigations and treatment.
Causes of Female Infertility
- Ovulation disorders: Infrequent, irregular, or absent ovulation due to conditions such as PCOS, hypothalamic dysfunction, premature ovarian insufficiency, or high prolactin levels.
- Fallopian tube damage or blockage (tubal infertility): Scarring or blockage of the tubes can prevent the egg and sperm from meeting, often due to pelvic inflammatory disease, endometriosis, or previous pelvic surgery.
- Uterine issues: Fibroids, polyps, congenital uterine anomalies, or adhesions (scar tissue) can interfere with embryo implantation and may increase the risk of miscarriage.
- Endometriosis: Growth of endometrial-like tissue outside the uterus can affect the ovaries, tubes, and uterine environment, reducing fertility.
- Cervical factors: Structural problems or issues with cervical mucus can make it harder for sperm to pass through the cervix and reach the uterus.
- Age-related decline: Female fertility decreases with age, especially after the mid-30s, because both the number and quality of eggs reduce over time.
- Lifestyle factors: Smoking, excessive alcohol intake, obesity, being underweight, and extreme exercise can negatively affect ovulation and overall fertility, while healthy habits can support treatment outcomes.
Causes of Male Infertility
Male infertility often relates to problems with sperm production, function, or delivery, but can also be linked to hormonal, genetic, or lifestyle factors.
- Sperm disorders: Low sperm count (oligospermia), absent sperm in the ejaculate (azoospermia), poor motility (asthenozoospermia), or abnormal sperm shape (teratozoospermia).
- Testicular issues: Conditions like varicocele, testicular infections, undescended testes, or previous injury can impair sperm production and quality.
- Ejaculation disorders: Problems such as retrograde ejaculation, where semen flows into the bladder, or severe premature ejaculation can hinder fertilization.
- Obstruction in ducts: Blockages in the epididymis, vas deferens, or ejaculatory ducts can prevent sperm from being released during ejaculation.
- Hormonal imbalances: Abnormal levels of hormones from the hypothalamus, pituitary gland, or testes can interfere with normal sperm production.
- Genetic factors: Certain genetic conditions and chromosomal abnormalities can lead to impaired sperm development or function.
- Lifestyle and environmental factors: Smoking, alcohol, recreational drugs, obesity, heat exposure, and environmental toxins can all reduce sperm quality and quantity and influence male fertility treatment outcomes.
Why Is Addressing Infertility Important?
Infertility is not only about difficulty in conceiving; it affects physical health, emotional well-being, relationships, and social life. Early evaluation and treatment provide medical answers, emotional support, and realistic options.
- Reproductive health and well-being: Infertility is a disease of the reproductive system and needs proper medical care as part of overall health.
- Emotional and psychological impact: Difficulty conceiving can cause sadness, anxiety, guilt, and depression, so timely support and counseling are essential.
- Relationship support: Infertility can strain relationships, and working through it together with guided support can strengthen communication and bonding.
- Achieving family-building goals: Many individuals and couples see parenthood as a central life goal; treatment offers a chance to fulfil that dream.
- Informed decision-making: Understanding causes and available options helps couples decide between different treatments, third-party options, adoption, or remaining child-free.
- Social and cultural pressures: In societies where childbearing is highly valued, infertility may lead to stigma or isolation; proper care and awareness can reduce this burden.
- Economic and health aspects: Managing infertility can be costly, and evaluation may also uncover other medical conditions that require attention and treatment.
Different Types of Fertility Treatments
Fertility treatment is personalised according to the cause of infertility, age of the partners, duration of trying, previous treatments, and individual preferences. Many couples benefit from a stepwise approach starting with simpler options before moving to advanced techniques.
- Fertility medications: Used especially for ovulation disorders to trigger or regulate ovulation in women and sometimes to support sperm production in men.
- Surgical procedures: Operations to correct structural problems such as blocked tubes, fibroids, polyps, endometriosis in women, or varicocele and duct blockages in men.
- Assisted Reproductive Technology (ART): Procedures where eggs and sperm are handled outside the body, including IVF and related techniques.
- Lifestyle modifications and complementary approaches: Weight management, quitting smoking, reducing alcohol, managing stress, and carefully chosen complementary therapies can support medical treatment.
Common Fertility Treatments
IUI (Intrauterine Insemination)
Intrauterine insemination is a simple fertility procedure in which washed, concentrated sperm are placed directly into the uterus around the time of ovulation to increase the number of sperm that reach the egg. It is often recommended for mild male factor infertility, unexplained infertility, or cervical factor issues and can be done with or without ovulation-stimulating medications.
The success of IUI depends on factors such as the woman’s age, the underlying cause of infertility, sperm parameters, and whether fertility drugs are used in the cycle.
IVF (In Vitro Fertilization)
IVF is a more advanced ART technique in which eggs are retrieved from the ovaries, fertilized with sperm in the laboratory, and resulting embryos are transferred into the uterus. It is widely used for blocked or damaged tubes, severe male factor infertility, endometriosis, ovulation problems, and unexplained infertility.
- Ovarian stimulation: Fertility medications are given to stimulate the ovaries to produce multiple mature eggs.
- Egg retrieval: Mature eggs are collected from the ovaries using a minimally invasive, ultrasound-guided procedure.
- Fertilization: Eggs are combined with sperm in the lab by conventional insemination or by ICSI, where a single sperm is injected into each egg.
- Embryo culture: Fertilized eggs are monitored as they develop into embryos over several days in controlled lab conditions.
- Embryo transfer: One or more carefully selected embryos are transferred into the uterus through a thin catheter.
- Pregnancy test: About two weeks after transfer, a blood test is done to check for pregnancy.
IVF success rates vary depending on age, egg and sperm quality, embryo development, and the underlying cause of infertility, but it remains one of the most effective treatment options for many couples.