Pregnancy is a wonderful gift. Almighty has bestowed many women with the miraculous power to give birth to a life. For couples, who are not blessed with their progeny, Infertility is no less than a curse.

For a woman to conceive – intercourse must take place around the time when an egg is released from her ovary. Husband’s and her reproductive system should be functional at optimum levels. She should have patent tubes to allow fertilization of eggs and a normal womb with balanced hormonal milieu to harbor the fetus for nine months.

According to the World health organization, “Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse in the absence of any other reason, such as breastfeeding or postpartum amenorrhoea.

Worldwide around 7-10 percent of couple are affected by Infertility.

Primary infertility is labeled when the couple has never had a successful live birth inspite of in union for five years without any contraception. However, Secondary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least five years since their last live birth, during which they did not use any contraceptives.

The obstetric history of still born and spontaneous miscarriages is not considered as pregnancy and such patients are also considered into primary infertility. Thus the distinguishing feature is whether or not the couple has ever had a pregnancy which led to a live birth.

What is responsible for Infertility?

infertility causes

What are the causes of Infertility in Males?

Male fertility peaks usually at age 25 and declines after age 40. The various causes of male infertility are categorized into –

Loss of libido.

  • Physical, mental, emotional and psychological stress resulting in change of preferences and lack of interest in sexual activity.
  • Pathological causes due to chronic physical illness especially neurological & metabolic disorders etc.

Erectile dysfunction & Premature ejaculation.

  • Psychological stress resulting in redistribution of blood to vital organs, depriving sexual organs.
  • Pathological diseases like trauma, neurological, diabetes and hypertensive vasculopathy etc.


Obstruction of genital tract that carry sperm form testis to penis leading to Aspermia.

  • Vasectomy for family planning.
  • Congenital malformation of genital tract.

Poor quantity or quality of sperms in semen due to testicular insufficiency.

  • Hormonal deficiency.
  • Viral infections like measles or chickenpox in childhood causing testicular injury.
  • Metabolic or chronic physical illness.
  • Pesticides and other environmental toxins
  • Varicocele (network of dilated blood vessels at the base of scrotum) resulting in hyperthermia may contribute in abnormal semen.

(Sperms need lesser temperature for survival, and hence, the testes are placed outside the body safely in scrotal bag. High temperature exposure to testes like furnaces, extremely hot weather, tight clothing, infection/ inflammation or abnormal blood supply etc can adversely affect sperms resulting in male factor infertility.)

What is normal semen analysis report?

According to WHO criteria in 2010.

who sperm analysis

  • Aspermia – Complete lack of semen.
  • Hypospermia – Small semen volume.
  • Azoospermia – Complete absence of sperms in semen.
  • Oligospermia – few sperms in semen.
  • Asthenospermia – reduced progressive sperm motility.
  • Necrospermia – Dead of immobile sperms.
  • Teratospermia – Sperm with abnormal morphology.
  • Pus cells – Presence of infections.

Treatment of Male Infertility


What are the causes of Female infertility?

Female fertility is high between 20-30 years of age, starts reducing after 30 and drastically falls after 35 with pregnancy occurring rarely after age 50.

The causes of female infertility are classified into –

pickup from 4A940219 Uterus with multiple pathologies affecting fertility MOD: section tube, add polyp, polycystic ovary, blockages, infection Source: Source: Netter, MD., Frank H. Ciba Collection of Medical Illustrations: Reproductive System, Vol 2. "Diseases of the Ovary," Section XI-Plates 2 and 3, page 194-95.

1- Ovulatory causes of Infertility :

In normal menstruating females with 21 to 35 days cycle, the ovulation may occur anytime between 7th to 21st days respectively. The life of released egg is only 24 hours during which the female is most fertile.

The ovulation can be detected by

  • Copious thin mucoid vaginal discharge.
  • Increase in basal body temperature. On the day of ovulation, the BBT may rise by 0.5 degree farenheit.
  • Ovulation predictor kits that detect luteinizing hormone in urine.
  • Progesterone hormone levels in blood. (In laboratory)

Potential causes of anovulation (absence of ovulation) include the following:

  1. PCOS: It is the most common cause of female infertility. It is a hormone problem associated with obesity, irregular menses, excess androgen activity (acne, hirsutism, acanthosis nigricans, hairfall), family history of diabetes mellitus, ultrasound suggestive of polycystic ovaries.
  2. Excessive physical or emotional stress resulting in hormonal imbalance and menstrual irregularity. It is called as Functional Hypothallamic Amenorrhoea.
  3. Anorexia nervosa- A psychological eating disorder characterized by a strong desire to be thin and food restriction due to fear of gaining weight resulting in low weight and subsequently hormonal disturbance.
  4. Diminishedovarian reserve (DOR). This occurs when the ability of the ovary to produce eggs is reduced because of congenital, medical, surgical, Premature ovarian failure or unexplained causes. Ovarian reserves naturally decline with age.
  5. Menopause – it is age appropriate decline in ovarian function that usually occurs between 40 to 50 years of age. After menopause, it is difficult to conceive with self eggs.

The tests that are recommended to access ovarian function:

No single test is a perfect predictor of fertility. However the commonly used tests are:

  • Follicular stimulating hormones on day 3-5 of the menstrual cycle.
  • Anti mullerian hormones.
  • Antral follicle count on transvaginal ultrasonography.

2- Fallopian Tubal causes of Infertility?

Blocked or unhealthy swollen fallopian tubes prevent fertilization of egg resulting in infertility.  The tubes may be affected due to –

  • Damage to inner lining of tubes due to Infections.
  • Intra-abdominal adhesions due to infections, pelvic inflammatory disease, endometriosis, previous surgery etc.
  • Congenital abnormal development of tube.
  • Presence of fibroids (benign tumors) at cornu of uterus.
  • Previous tubal ligation surgery as a family planning.
  • Removal of tubes due to ectopic pregnancy or any other pathology.

The patency of tubes may be evaluated by

infertility investigations

  • Hysterosalphingography (HSG)-

It is an X-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes. This helps evaluate tubal caliber (diameter) and patency. The patient may experience pain, syncope, dye reactions etc.

  • Saline infusion sonography (SIS)-

The patency is checked by infusing normal saline and evaluating under ultrasonography. It is less painful and there is no risk of dye reactions.

  • Diagnostic Hystero-Laparoscopy –

It is a kind of surgery, where a special telescope called laparoscope, is inserted into the abdomen and the inside is visualized. It is often clubbed with diagnostic hysteroscopy (visualization of inner uterine cavity with the help of hysteroscope). The methylene-blue dye is injected into the uterus and tubal patency checked.

3– Uterine causes?

The uterus provides a home to the fetus. The following uterine pathologies may lead to infertility-

  • Congenital absence of uterus/ vagina or their lumen.
  • Abnormal structural development of uterus resulting in bicornuate uterus or septate uterus. Very often these congenital abnormalities lead to pregnancy losses than infertility.
  • Intrauterine adhesions due to previous surgery like D&C, infections like tuberculosis, retained products of conception etc.
  • Presence of intra-cavity or sub-mucous fibroids

4- Miscellaneous causes?

  • Infections – Sexually transmitted diseases can cause infertility by causing PID, blocking fallopian tubes, adverse intrauterine environment and recurrent early pregnancy losses.
  • Genetic factors – Chromosomal and genetic defects can lead to recurrent spontaneous abortions or complete infertility.
  • DNA damage in eggs/ sperms by smoking, radiation, drugs, infections.
  • Hormonal disturbances like Diabetes mellitus, Thyroid diseases etc.
  • Chronic severe diseases like kidney or liver diseases, chronic infections like tuberculosis, chemotherapy/radiotherapy etc.
  • Immunological intolerance due to production of abnormal antibodies against self or husband’s antigen like anti-sperm antibodies, Anti-phospholipid antibody syndrome, etc.
  • Thrombophilia ( abnormality of blood coagulation that increases risk of blood clot formation and poor blood circulation)
  • Toxins such as tobacco, alcohol, pesticides etc.

 5- Unexplained infertility

Up to 10-20% of infertile couples have unexplained infertility. In these cases abnormalities are likely to be present but not detected by current methods.

Effects of Infertility –

Psychological Impact-

  • Emotional distress resulting in hopelessness, helplessness and worthlessness.
  • Suicidal tendency.
  • Loss of control and doubting one’s womanhood.
  • Stigmatization and social isolation.
  • Sexual dysfunction and loss of libido.
  • Psychosomatic diseases like frequent headaches, gastric upset, palpitations, mood swings, high blood pressure, eating disorders etc.

Emotional stress, family disharmony and marital difficulties are greater in couples where the infertility lies with the man.


Social impact –

  • Social isolation. May be self due to guilt or forced by the society due to prevailing customs.
  • Family disharmony.
  • Increased incidence of forced incest in some families.

Financial impact –

  • The amount money and loss of work hours involved in the treatment of infertility may be exorbitant.

Physical health impact –

  • Psychosomatic diseases like frequent headaches, gastric upset, palpitations, mood swings, high blood pressure, eating disorders etc.
  • The high doses of hormonal injections may sometimes affect adversely.


The management of infertility depends upon the age of the couple, duration of natural attempt, responsible causes and associated factors.

The treatment of infertility includes-

  1. Family counseling.
  2. Healthy life style and optimum weight management to correct hormonal milieu.
  3. Assisted reproductive technologies like

a- Intrauterine Insemination –


It is the deliberate introduction of male’s healthy sperms achieved by seminal wash into female’s uterus.

The ovulation induction drugs are prescribed to help 1 or 2 eggs grow. When the egg is 20-22 mm large and endometrial thickness is optimum 7 to 9 mm, the prepared sperms are injected into the uterine cavity with the help of special cannula so that the fertilization occurs inside the body.

b- Invitro fertilization –


The ovaries are stimulated to increase egg production. The maximum possible mature eggs are retrieved and fertilized by sperms outside the body producing embryos. One or more healthy embryos are transferred into the uterine cavity. With the method of ICSI, the DNA of sperm may directly be injected into the egg.

  • When either eggs or sperms of couple are of poor quality, the donor eggs or sperms can be offered.
  • If the womb or body of mother is not suitable to carry pregnancy, the embryo is transferred into a rent out womb that is called as surrogacy.

The success of Infertility treatment is assessed by the rate of live birth. It is only around 40-50 percent.

To understand this low rate of success, let us take an example. If we sow 100 good quality seeds, few would fail to germinate, some would be arrest at plant or bust stage and only around 40-50 percent would attain their potential to become tree. Like seeds, the live birth rate of embryo depends on many factors like, genetic potential of the embryo, its structural development, safe uterine and hormonal environment, optimum nourishment through the placenta etc.

Law is simple – “Survival of the Fittest“. The healthy embryo would find its place in this world by any means, & the progeny would continue


The information is shared to create awareness towards Pregnancy and Childcare to reduce maternal and child deaths. Atmost care has been taken by the author to include the verified information from authentic sources. However, kindly discuss the same with your health care provider before implementation.